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Peppermint Oil Solution Is Useful as an Antispasmodic Drug for Esophagogastroduodenoscopy, Especially for Elderly Patients

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  • IMAGAWA Medical Clinic

Abstract and Figures

Although hyoscine butyl bromide (HB) and glucagon (GL) are often used as antispasmodic drugs during esophagogastroduodenoscopy (EGD), these agents may cause adverse effects. Recently, it was reported that peppermint oil solution (PO) was very effective and had few side effects. We clarified the efficacy and usefulness of PO as an antispasmodic during upper endoscopy, especially for elderly patients. This study was a non-randomized prospective study. The antispasmodic score (1-5, where 5 represents no spasm) was defined according to the degree of spasms of the antrum and difficulty of biopsy. We compared the antispasmodic scores between non-elderly patients (younger than 70) and elderly patients (70 years old or older) according to the antispasmodic agent. A total of 8,269 (Group PO: HB: GL: NO (no antispasmodic) = 1,893: 6,063: 157: 156) EGD procedures were performed. There was no significant difference in the antispasmodic score between Group PO (mean score ± standard deviation: 4.025 ± 0.925) and Group HB (4.063 ± 0.887). Among the non-elderly patients, those in Group PO (n = 599, 3.923 ± 0.935) had a worse antispasmodic score than those in Group HB (n = 4,583, 4.062 ± 0.876, P < 0.001). However, among the elderly patients, those in Group PO (n = 1,294, 4.073 ± 0.917) had similar scores to those in Group HB (n = 1,480, 4.064 ± 0.921, P = 0.83), and significantly better scores than those in Group GL (n = 69, 3.797 ± 0.933, P < 0.05). Peppermint oil was useful as an antispasmodic during EGD, especially for elderly patients.
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1 23
Digestive Diseases and Sciences
ISSN 0163-2116
Volume 57
Number 9
Dig Dis Sci (2012) 57:2379-2384
DOI 10.1007/s10620-012-2194-4
Peppermint Oil Solution Is Useful
as an Antispasmodic Drug for
Esophagogastroduodenoscopy, Especially
for Elderly Patients
Atsushi Imagawa, Hidenori Hata,
Morihito Nakatsu, Yasunari Yoshida,
Keiko Takeuchi, Toshihiro Inokuchi,
Takayuki Imada, et al.
1 23
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ORIGINAL ARTICLE
Peppermint Oil Solution Is Useful as an Antispasmodic Drug
for Esophagogastroduodenoscopy, Especially for Elderly Patients
Atsushi Imagawa Hidenori Hata Morihito Nakatsu Yasunari Yoshida
Keiko Takeuchi Toshihiro Inokuchi Takayuki Imada Yoshiyasu Kohno
Masahiro Takahara Kazuyuki Matsumoto Hirokazu Miyatake
Satoru Yagi Masaharu Ando Mamoru Hirohata Shigeatsu Fujiki
Ryuta Takenaka
Received: 7 December 2011 / Accepted: 14 April 2012 / Published online: 6 May 2012
ÓSpringer Science+Business Media, LLC 2012
Abstract
Background Although hyoscine butyl bromide (HB) and
glucagon (GL) are often used as antispasmodic drugs
during esophagogastroduodenoscopy (EGD), these agents
may cause adverse effects. Recently, it was reported that
peppermint oil solution (PO) was very effective and had
few side effects.
Aim We clarified the efficacy and usefulness of PO as an
antispasmodic during upper endoscopy, especially for
elderly patients.
Methods This study was a non-randomized prospective
study. The antispasmodic score (1–5, where 5 represents no
spasm) was defined according to the degree of spasms of the
antrum and difficulty of biopsy. We compared the anti-
spasmodic scores between non-elderly patients (younger
than 70) and elderly patients (70 years old or older)
according to the antispasmodic agent.
Results A total of 8,269 (Group PO: HB: GL: NO (no
antispasmodic) =1,893: 6,063: 157: 156) EGD procedures
were performed. There was no significant difference in the
antispasmodic score between Group PO (mean score ±
standard deviation: 4.025 ±0.925) and Group HB (4.063 ±
0.887). Among the non-elderly patients, those in Group PO
(n=599, 3.923 ±0.935) had a worse antispasmodic score
than those in Group HB (n=4,583, 4.062 ±0.876,
P\0.001). However, among the elderly patients, those in
Group PO (n=1,294, 4.073 ±0.917) had similar scores
to those in Group HB (n=1,480, 4.064 ±0.921, P=
0.83), and significantly better scores than those in Group
GL (n=69, 3.797 ±0.933, P\0.05).
Conclusion Peppermint oil was useful as an antispas-
modic during EGD, especially for elderly patients.
Keywords Antispasmodic drug
Esophagogastroduodenoscopy Peppermint oil
Introduction
Hyoscine butyl bromide (HB) (Buscopan 20 mg; Nippon
Boehringer Ingelheim, Hyogo, Japan) and glucagon (GL)
(Glucagon G Novo 1 mg; Novo Nordisk Pharma, Tokyo,
Japan) are often used as antispasmodic drugs during eso-
phagogastroduodenoscopy (EGD) in Japan. However, HB
may cause adverse effects, for example palpitation, ische-
mic heart disease, dry mouth, and urinary retention. GL
may cause hyperglycemia and reactive hypoglycemia
[1,2]. Because the average lifespan of individuals is
increasing, the number of elderly patients undergoing
endoscopic procedures is also increasing. Endoscopists
should take into account a variety of underlying diseases in
elderly patients and should take steps during preparation
for the procedure to avoid the occurrence of adverse
events. Therefore, we feel it is crucial to maintain stable
conditions in the patient and reduce the risk of complica-
tions of the procedure, especially for elderly patients.
Peppermint oil has been used to treat irritable bowel
syndrome for hundreds of years as a digestive aid and
Clinical trial registration number: UMIN00000 4710.
A. Imagawa (&)H. Hata M. Nakatsu Y. Yoshida
K. Takeuchi T. Inokuchi T. Imada Y. Kohno
M. Takahara K. Matsumoto H. Miyatake S. Yagi
M. Ando M. Hirohata
Department of Gastroenterology, Mitoyo General Hospital,
708 Himehama, Toyohama, Kan-onji, Kagawa 769-1695, Japan
e-mail: imagawa-gi@umin.ac.jp
S. Fujiki R. Takenaka
Endoscopy Center, Tsuyama Central Hospital, Okayama, Japan
123
Dig Dis Sci (2012) 57:2379–2384
DOI 10.1007/s10620-012-2194-4
Author's personal copy
carminative [37]. Peppermint oil relaxes the tone of
gastrointestinal tract sphincters and aids the passage of
gas. The active component in peppermint oil is menthol,
which blocks calcium channels of smooth muscle [8,9].
Recently, it was reported that peppermint oil solution (PO)
is highly effective and has few side effects as an anti-
spasmodic agent during upper endoscopy and endoscopic
retrograde cholangiopancreatography (ERCP) [10,11].
Moreover, the peculiar aroma of this solution may reduce
stress and anxiety in patients undergoing the procedure
[12].
The objective of this study was to clarify the efficacy
and usefulness of peppermint oil solution as an antispas-
modic during EGD, especially for elderly patients.
Materials and Methods
Patients
Patients who were scheduled to undergo EGD were
recruited for this non-randomized prospective study. The
following patients were excluded from this study: patients
with clinical evidence of severe disease, for example
American Society of Anesthesiologists (ASA) classifica-
tion of 4 or 5 at the time of EGD, patients with peppermint
allergy, and patients who were pregnant or lactating.
Patients with remnant stomach were also excluded because
it was impossible to evaluate movement of the antrum
during EGD.
The exclusion criteria for using HB and GL are as
described below. This study was approved by the Institu-
tional Review Boards of the Faculty of Mitoyo General
Hospital and Tsuyama Central Hospital. All patients pro-
vided written informed consent to participate in the study
and the EGD procedure.
Selection of the Antispasmodic Agent
All patients were asked about the presence of diseases
before the EGD procedure. The age of the patients, and
commonly-used medicines were also confirmed. For each
patient, the antispasmodic agent was selected according to
the judgment of the endoscopist who took into consider-
ation the patient’s age and underlying diseases. As a gen-
eral rule, HB was avoided for patients with severe heart
disease, prostate hypertrophy, and narrow angle glaucoma.
GL was avoided for patients with severe diabetes mellitus
and phaeochromocytoma. HB and GL were administered
by intramuscular or intravenous injection 3–5 min before
the EGD procedure.
Peppermint Oil Solution
Peppermint oil solution was prepared by mixing pepper-
mint oil (Yoshida Pharmaceutical, Tokyo, Japan), distilled
water, and the catalyst sorbitan monostearate (Wako Pure
Chemical Industries, Osaka, Japan). Approximately 20 ml
1.6 % peppermint oil solution was administered directly to
the antrum of the stomach at the initial stage of the EGD
procedure [8].
A total of 8,269 EGD procedures were carried out at
Mitoyo General Hospital, Kagawa Prefecture, and Tsuy-
ama Central Hospital, Okayama Prefecture, in Japan from
March 2007 to September 2010. Peppermint oil was
administered intraluminally during EGD to 1,893 patients
(Group PO) with heart disease, prostate hypertrophy, or
narrow angle glaucoma. HB was administered to 6,063
patients (Group HB) and GL was administered to 157
patients (Group GL) before EGD. For the remaining 156
patients (Group NO), EGD was carried out without anti-
spasmodic agents.
Assessment of Antispasmodic Effect in EGD
The main outcome of this study was to compare the anti-
spasmodic scores for the non-elderly group (patients
younger than 70 years) and elderly group (patients
70 years or older) and their dependence on antispasmodic
agent. The secondary objective was to compare the anti-
spasmodic scores of Group PO patients who did or did not
have atrophy in the stomach as evaluated from the endo-
scopic findings. We also compared the scores for non-
elderly patients and elderly patients in Group PO.
We used a scale of 1–5 (where 5 represents no spasm) to
rate the degree of spasm of the antrum during EGD and the
degree of difficulty of the biopsy procedure, in accordance
with the previous report of Niwa et al. [13]. In cases where
there was severe spasm of the antrum during EGD and
biopsy could not be performed, indicating that the medi-
cation was ineffective, an antispasmodic score of 1 was
assigned. An antispasmodic score of 2 meant there was
severe spasm of the antrum during EGD and biopsy
was difficult to perform, indicating that the medication was
slightly effective. A score of 3 meant there was moderate
spasm of the antrum and biopsy was easy to perform,
indicating that the medication was moderately effective. A
score of 4 meant there was slight spasm of the antrum and
biopsy was easy to perform, indicating that the medication
was effective. A score of 5 meant that biopsy was easy to
perform in the absence of movement of the antrum, indi-
cating that the medication was very effective.
Twenty-nine endoscopists belonged to the endoscopy
centers where this study was conducted during the study
period. All endoscopists had more than three years’
2380 Dig Dis Sci (2012) 57:2379–2384
123
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experience in performing EGD. The endoscopists assigned
the score immediately after the EGD procedure. The scores
were entered in a database. If the EGD was conducted
without performing a biopsy, the endoscopists assigned the
score according to the degree of spasm of the antrum
during EGD. Because the number of patients who were
taking oral antithrombotic drugs has been increasing and
magnified endoscopy has been developed, in fact, 60–70 %
of the patients underwent EGD without biopsy.
Statistical Analysis
All eligible patients with evaluable data who underwent
EGD during the study period were enrolled. Continuous
data are expressed as mean ±standard deviation (SD). The
coefficient of variation (CV: (SD/mean) 9100) of the
antispasmodic scores was assessed. Statistical analysis was
performed by use of JMP 6 software (SAS Institute, Cary,
NC, USA). Patient characteristics were compared among
the groups using Fisher’s exact test. For the antispasmodic
scores, the Wilcoxon rank sum test was used to assess the
significance of differences in two independent groups and
the Kruskal–Wallis test was used to assess the significance
of differences in more than two independent groups.
P\0.05 was considered statistically significant.
Results
A total of 8,269 subjects who underwent EGD were
enrolled in this study. The mean age of the 8,269 subjects
who underwent EGD was 62.4 years (range 13–99 years).
The male/female ratio was 4,788/3,481. HB, PO, GL, or no
antispasmodic drug was administered to 6,063, 1,893, 157,
and 156 subjects, respectively. Group HB was significantly
younger than Groups PO, GL, and NO. In contrast, the
proportion of elderly patients over 70 years was signifi-
cantly higher and the male/female ratio tended to be higher
in Group PO than in Group HB. Groups GL and NO
consisted of small numbers of cases, because there was a
tendency to choose peppermint oil in elderly patients who
had a variety of underlying conditions (Table 1).
The antispasmodic score of Group PO (n=1,893,
4.025 ±0.925) did not significantly differ from that of
Groups HB (n=6,063, 4.063 ±0.887, P=0.23) and GL
(n=157, 3.924 ±0.895, P=0.12). The antispasmodic
score of Group HB was significantly higher than that of
Groups NO (n=156, 3.846 ±1.073, P\0.05) and GL
(P\0.05) (Fig. 1). The overall CV for the antispasmodic
score was 22.2 %.
Table 1 Patient characteristics and comparison of antispasmodic score among the groups
Total Group HB Group PO Group GL Group NO
No. of cases 8,269 6,063 1,893 157 156
Age (years) 62 ±14 59 ±14 73 ±11* 67 ±11* 73 ±11*
M/F 1.38 1.25 1.74* 3.13* 1.79**
4,788/3,481 3,368/2,695 1,201/692 119/38 100/56
Mean score
All patients 4.048 4.063 4.025 3.924 3.846
Under 70 years 4.044 4.062 3.923 4.023 3.778
(n) (5,315) (4,583) (599) (88) (45)
70 years and older 4.055 4.064 4.073 3.797 3.874
(n) (2,954) (1,480) (1,294) (69) (111)
HB hyoscine butyl bromide, PO peppermint oil solution, GL glucagon, NO no antispasmodic
*P\0.0001; ** P\0.05 compared with Group HB
4.063 4.025 3.924 3.846
1
1.5
2
2.5
3
3.5
4
4.5
5
HB PO GL NO
No. of cases 6063 1893 157 156
P<0.05
P=0.23 P=0.12
P<0.05
P=0.09
Fig. 1 Comparison of antispasmodic scores among the four groups
who received PO, HB, GL, or no antispasmodic agent. The antispas-
modic score of Group PO (n=1,893, mean score =4.025 ±0.925)
did not significantly differ from that of Groups HB (n=6,063,
score =4.063 ±0.887, P=0.23) and GL (n=157, score =
3.924 ±0.895, P=0.12). Group HB had a significantly higher
antispasmodic score than Groups NO (n=156, score =3.846 ±
1.073, P\0.05) and GL (P\0.05)
Dig Dis Sci (2012) 57:2379–2384 2381
123
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Next, the data were analyzed separately among the non-
elderly patients under age 70 years and among the elderly
patients 70 years and older. Among the patients younger
than 70 years, patients in Group PO (n=599, 3.923 ±
0.935) had a significantly worse antispasmodic score than
those in Group HB (n=4,583, 4.062 ±0.876, P\
0.001). The antispasmodic score of Group PO did not
significantly differ from that of Group GL (n=88,
4.023 ±0.857, P=0.42) or Group NO (n=45, 3.778 ±
0.974, P=0.34) (Fig. 2). In contrast, among the elderly
patients 70 years or older, Groups PO and HB had similar
antispasmodic scores (Group PO (n=1,294, 4.073 ±
0.917) vs. Group HB (n=1,480, 4.064 ±0.921, P=
0.83)). In addition, Group PO had a significantly better
antispasmodic score than Group GL (n=69, 3.797 ±
0.932, P\0.05) (Fig. 3).
Among the patients in Group PO, we were able to
endoscopically evaluate whether or not there was atrophy
in the stomach in 437 patients. There was no significant
difference in the antispasmodic score between those with
atrophy in the stomach (n=356, 4.213 ±0.894) and
those without atrophy (n=81, 4.086 ±0.977, P=0.33).
In contrast, peppermint oil had a stronger antispasmodic
effect in elderly patients (n=1,294, 4.073 ±0.917) than
in non-elderly patients (n=599, 3.923 ±0.935, P\
0.001) (Fig. 4). This result showed that peppermint oil had
a weak antispasmodic effect in non-elderly patients.
However, our results showed that peppermint oil in elderly
patients was not inferior to HB and GL, although there
were many high-risk patients with an underlying disease in
Group PO. There were no severe adverse effects including
severe heartburn in any patient during and after the EGD
procedure in this study.
Discussion
This study showed that peppermint oil solution is effective
and useful as an antispasmodic drug for EGD, especially
for elderly patients. Endoscopists should always consider
the background of the patients in order to carry out a safe
procedure. For elderly patients, the risk of complications of
EGD is increased, and the general condition of the patients
becomes unstable during EGD, because of their underlying
disease.
Peppermint oil has been used for treatment of irritable
bowel syndrome and functional dyspepsia [37,14]. In
addition, it has been used as an herbal medicine since
ancient times and is used in many foods [12]. Peppermint
oil is a safe medication for elderly people because there are
no severe side effects including allergic reaction if a nor-
mal volume is used, although heartburn, perianal burning,
blurred vision, nausea, and vomiting were common adverse
effects of peppermint oil reported in clinical trials [6].
When peppermint oil is administered orally, menthol, one
of its important constituents, is rapidly absorbed and
metabolized to its glucuronide salt, which is excreted
almost entirely in the urine [15]. Peppermint oil has been
reported to reduce spasm during colonoscopy, ERCP, and
barium enema examination [10,11,1622]. It can also be
expected to have an anti-anxiety and relaxing effect on
patients because of its unique aroma.
In addition, there were some advantages for patients
who received PO. For medical staff, by eliminating needle
4.062 3.923 4.023
3.778
1
1.5
2
2.5
3
3.5
4
4.5
5
HB PO GL NO
No. of cases 4583 599 88 45
Antispasmodic score
P<0.05
P=0.34
P=0.59
P<0.001 P=0.42
Fig. 2 Comparison of antispasmodic scores for non-elderly patients
in the four groups who received PO, HB, GL, or no antispasmodic
agent. Patients in Group PO (n=599, score 3.923 ±0.935) had a
significantly worse antispasmodic score than those in Group HB
(n=4,583, score 4.062 ±0.876, P\0.001). There were no signif-
icant differences in the antispasmodic score between Group PO versus
Group GL (n=88, score 4.023 ±0.857, P=0.42) or Group NO
(n=45, score 3.778 ±0.974, P=0.34)
4.064 4.073
3.797 3.874
1
1.5
2
2.5
3
3.5
4
4.5
5
HB PO GL NO
No.of cases 1480 1294 69 111
Antispasmodic score
P<0.05
P=0.83 P<0.05
P=0.17
P=0.15
Fig. 3 Comparison of antispasmodic scores for elderly patients in the
four groups who received PO, HB, GL, or no antispasmodic agent.
Elderly patients in Group PO (n=1,294, score 4.073 ±0.917) had a
similar antispasmodic score to those in Group HB (n=1,480, score
4.064 ±0.921, P=0.83), and a significantly better score than those
in Group GL (n=69, score =3.797 ±0.933, P\0.05)
2382 Dig Dis Sci (2012) 57:2379–2384
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Author's personal copy
injection, the risks and burdens of pre-medication were
reduced. For the patients, the probability of needle-stick
injury decreased and the length of time of the endoscopy
procedure was shortened.
The main objective of this study was to compare the
antispasmodic effect of PO with that of HB and GL.
Although an antispasmodic effect was observed at nearly
satisfactory levels for all patients, the antispasmodic effect
for non-elderly patients who received peppermint oil was
insufficient. This study also demonstrated that peppermint
oil had a stronger antispasmodic effect in elderly patients
than in non-elderly patients; however, the antispasmodic
effect of peppermint oil was not affected by the presence of
atrophy of the gastric mucosa. The reason for this result is
unclear.
This study has some limitations. First, there was bias with
higher percentages of males and elderly people in Group PO.
This bias may be regarded as acceptable because of the
background of the patients. The second limitation is that the
antispasmodic score was assigned mainly by subjective
assessment. The ideal study may be to randomly assign non-
risk patients to groups HB and PO, and high-risk patients to
groups PO and NO. The third limitation of this study is that
the endoscopists were not unaware of the drugs being
administered; making them unaware would have been dif-
ficult because of the unique fragrance of peppermint oil. The
fourth limitation is that peppermint oil has the drawback that
it is necessary to use a catalyst to mix the water and menthol
and preparation of this solution is slightly complex. This
problem was resolved by assistance of pharmacists at the two
hospitals. Ingestion of PO has been suggested to increase
symptoms of gastro-esophageal reflux disease [3]. However,
in our study, no patient who received peppermint oil devel-
oped heartburn and chest discomfort during or after the
procedure.
Another unique characteristic of peppermint oil is its
long length of effectiveness. In our experience, although a
few minutes were required for the effect of peppermint oil
to appear, it was expected that the duration of the anti-
spasmodic effect of peppermint oil would be 20 min or
longer because no patient developed relapse of movement
during EGD. Therefore, it is thought that peppermint oil,
which can be administered at any time, would also be
suitable for procedures that take a long period of time, for
example complex endoscopic treatment.
In conclusion, because PO was effective as an anti-
spasmodic agent during EGD, for the elderly in particular,
its use was suitable and sufficient for conventional EGD.
Acknowledgments The authors thank Ms Sachiyo Kondo, a
member of the Department of Pharmacy, Tsuyama Central Hospital,
and Mr Masashi Katagiri and Mr Eiji Mukai, members of the
Department of Pharmacy, Mitoyo General Hospital, for their coop-
eration and assistance in this study. The authors thank Dr Yasuhiro
Miyake for assistance in the preparation of this manuscript.
Conflict of interest No conflicts of interest exist.
References
1. Hashimoto T, Adachi K, Ishimura N, et al. Safety and efficacy
of glucagon as a premedication for upper gastrointestinal
endoscopy—a comparative study with butyl scopolamine bro-
mide. Aliment Pharmacol Ther. 2002;16:111–118.
4.086 4.213
1
1.5
2
2.5
3
3.5
4
4.5
5
non -atrophy atrophy
3.923 4.073
1
1.5
2
2.5
3
3.5
4
4.5
5
non -elderly elderly
No. of cases 81 356 599 1294
Antispasmodic score
P<0.001P=0.33
Fig. 4 Comparison of antispasmodic scores among patients who
received PO according to presence of atrophy in the stomach and
according to whether they were elderly. There was no significant
difference in antispasmodic score between patients without atrophy
(n=81, 4.086 ±0.977) and patients with atrophy (n=356,
4.213 ±0.894, P=0.33) in the stomach. In contrast, peppermint
oil was more effective as an antispasmodic agent in elderly patients
(n=1,294, 4.073 ±0.917) than in non-elderly patients (n=599,
3.923 ±0.935, P\0.001)
Dig Dis Sci (2012) 57:2379–2384 2383
123
Author's personal copy
2. Umegaki E, Abe S, Tokioka S, et al. Risk management for gas-
trointestinal endoscopy in elderly patients: questionnaire for
patients undergoing gastrointestinal endoscopy. J Clin Biochem
Nutr. 2010;46:73–80.
3. Rees WD, Evans BK, Rhodes J. Treating irritable bowel syn-
drome with peppermint oil. Br Med J. 1979;2:835–836.
4. Nolen HW III, Friend DR. Menthol-beta-D—a potential prodrug
for treatment of the irritable bowel syndrome. Pharm Res.
1994;11:1707–1711.
5. Cappello G, Spezzaferro M, Grossi L, Manzoli L, Marzio L.
Peppermint oil (Mintoil) in the treatment of irritable bowel syn-
drome: a prospective double blind placebo-controlled randomized
trial. Dig Liver Dis. 2007;39:530–536.
6. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome:
a critical review and meta-analysis. Am J Gastroenterol. 1998;93:
1131–1135.
7. Bell GD. Premedication, preparation, and surveillance. Endos-
copy. 2002;34:2–12.
8. Hills JM, Aaronson PI. The mechanism of action of peppermint
oil on gastrointestinal smooth muscle. An analysis using patch
clamp electrophysiology and isolated tissue pharmacology in
rabbit and guinea pig. Gastroenterology. 1991;101:55–65.
9. Beesley A, Hardcastle J, Hardcastle PT, Taylor CJ. Influence of
peppermint oil on absorptive and secretory processes in rat small
intestine. Gut. 1996;39:214–219.
10. Hiki N, Kurosaka H, Tatsutomi Y, et al. Peppermint oil reduces
gastric spasm during upper endoscopy: a randomized, double-
blind, double-dummy controlled trial. Gastrointest Endosc.
2003;57:475–482.
11. Yamamoto N, Nakai Y, Sasahira N, et al. Efficacy of peppermint
oil as an antispasmodic during endoscopic retrograde cholangi-
opancreatography. J Gastroenterol Hepatol. 2006;21:1394–1398.
12. Nair B. Final report on the safety assessment of Mentha piperi-
ta(peppermint) oil, Mentha piperita (peppermint) leaf extract,
Mentha piperita (peppermint) leaf, and Mentha piperita (pep-
permint) leaf water. Int J Toxicol. 2001;20:61–73.
13. Niwa H, Nakamura T, Fujino M. Endoscopic observation on
gastric peristalsis and pyloric movement (in Japanese with Eng-
lish abstract). Gastroenterol Endosc. 1975;17:236–242.
14. May B, Kohler S, Schneider B. Efficacy and tolerability of a fixed
combination of peppermint oil and caraway oil in patients suf-
fering from functional dyspepsia. Aliment Pharmacol Ther.
2000;14:1671–1677.
15. Somerville KW, Richmond CR, Bell GD. Delayed release pep-
permint oil capsules(Colpermin) for the spastic colon syndrome:
a pharmacokinetic study. Br J Clin Pharmacol. 1984;18:638–640.
16. Leicester RJ, Hunt RH. Peppermint oil to reduce colonic spasm
during endoscopy. Lancet. 1982;2:989.
17. Kingham JG. Peppermint oil and colon spasm. Lancet. 1995;
346:986.
18. Asao T, Mochiki E, Suzuki H, et al. An easy method for the
intraluminal administration of peppermint oil before colonoscopy
and its effectiveness in reducing colonic spasm. Gastrointest
Endosc. 2001;53:172–177.
19. Jarvis LJ, Hogg JIC, Houghton CD. Topical peppermint oil for
the relief of colonic spasm at barium enema. Clin Radiol. 1992;
42:435.
20. Sparks MJ, O’Sullivan P, Herrington AA, Morcos SK. Does
peppermint oil relieve spasm during barium enema? Br J Radiol.
1995;68:841–843.
21. Asao T, Kuwano H, Ide M, et al. Spasmolytic effect of pepper-
mint oil in barium during double-contrast barium enema com-
pared with Buscopan. Clin Radiol. 2003;58:301–305.
22. Mizuno S, Kato K, Ono Y, et al. Oral peppermint oil is a useful
antispasmodic for doublecontrast barium meal examination.
J Gastroenterol Hepatol. 2006;21:1297–1301.
2384 Dig Dis Sci (2012) 57:2379–2384
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... Although its application in elderly patients was mentioned in some studies, no well-designed RCT was conducted until now. A non-randomized trial showed that the antispasmodic effect of peppermint oil was similar to HBB in elderly patients, but inferior to HBB in non-elderly patients 31 . However, there was bias in this study because higher percentages of males and elderly people were noted in the peppermint oil group than the HBB group, and the endoscopists were aware of the drugs being administered. ...
... Half of the elderly had AEs after EGD, with the incidence rate higher than the results of previous studies enrolling the general population 22,23,28,29 . This is reasonable because the risk of complications of EGD was increased for elderly patients due to their underlying disease 31 . Importantly, all the AEs were mild and similar in the two groups, suggesting those were related to EGD itself rather than the drug effects. ...
Article
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Hyoscine- N -butylbromide (HBB) is the most used antiperistaltic agent during esophagogastroduodenoscopy (EGD). However, almost half of the elderly have a contraindication to HBB. We aimed to evaluate l -menthol’s antiperistaltic effect and safety for EGD in the elderly with contraindication to HBB. This prospective, randomized, double-blind, placebo-controlled study screened 86 elderly patients (≥ 65 years old) scheduled to undergo EGD, and 52 of them with contraindication to HBB were enrolled. The participants were randomized to receive l -menthol ( n = 26) or a placebo ( n = 26), which was locally sprayed on the gastric antrum endoscopically. The proportion of patients with no or mild peristalsis after medication and at the end of EGD was significantly higher in the l -menthol group (76.9%) than in the placebo group (11.5%, p < 0.001). l -Menthol administration significantly reduced peristaltic grade, improved contraction parameters, and eased intragastric examination relative to the placebo ( p < 0.001, respectively). Hemodynamic changes, adverse events, and discomfort levels of patients were similar between the two groups. l -Menthol is an effective and safe alternative antiperistaltic medication for EGD in elderly patients with contraindication to HBB. Further large, randomized trials are required to clarify whether l -menthol can lead to better detection yield in the elderly. Clinical trial registration: The study was registered at ClinicalTrials.gov (NCT04593836).
... However, most antispasmodics, such as hyoscine butylbromide (Buscopan 1 ), cimetropium bromide (Algiron 1 ), atropine, and glucagon, must be injected. The administration of a drug via intravenous or intramuscular injection can cause pain and anxiety in a patient and increase medical costs [7]. Moreover, these drugs are recommended with caution as they cause potential adverse effects, such as dry mouth, urinary retention, temporary impairment of visual accommodation, palpitation, anaphylactic shock, and hyperglycemia [4,[8][9][10][11]. ...
... Second, we did not evaluate the satisfaction of patients with oral phloroglucinol. Since it is well known that oral formulations are expected to reduce patient discomfort and anxiety associated with needle injections [7], additional research should be performed regarding patient satisfaction with oral phloroglucinol in line with current medical trends of patient-centered medicine. ...
Article
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Background Anti-spasmodic agents are commonly injected during esophagogastroduodenoscopy (EGD) to improve visualization of the gastric mucosa by inhibiting gastrointestinal (GI) peristalsis. The availability of oral anti-spasmodic agents would increase convenience. In this study, we evaluated the effectiveness of oral phloroglucinol (Flospan ® ) as a premedication for unsedated EGD. Methods A prospective, double-blinded, placebo-controlled, randomized controlled trial was conducted in a tertiary hospital. Individuals scheduled to undergo unsedated EGD were randomly assigned to receive either oral phloroglucinol or matching placebo 15 min before EGD. The primary outcome was the rate of complete gastric peristalsis suppression. Outcomes were assessed by independent investigators according to the classification of gastric peristalsis and ease of intragastric observation at the beginning (Period A) and end (Period B) of EGD. Results Overall, 71 phloroglucinol-treated and 71 placebo-treated participants (n = 142 total) were included. The phloroglucinol group showed significantly higher proportions of participants with complete gastric peristalsis suppression than the placebo group (22.5% vs. 9.9%, P = 0.040). The ease of intragastric observation was significantly better in the phloroglucinol group than in the placebo group at Periods A (P < 0.001) and B (P = 0.005). Patients in both groups had comparable adverse events and showed willingness to take the premedication at their next examination. Conclusions Oral phloroglucinol significantly suppressed gastrointestinal peristalsis during unsedated EGD compared with placebo (Clinical trial registration number: NCT03342118 ).
... Gastrointestinal hyperperistalsis is another situation that affects endoscopic visualization through the disturbance caused by the procedure itself. Peppermint oil by intraluminal administration could act as an antispasmodic agent with useful advantages for endoscopic diagnosis of the margins of gastric tumors [31][32][33]. The aim of this study is to compare the effects of simethicone, NAC, sodium bicarbonate and peppermint as pre-medications on visualization of upper gastrointestinal endoscopy. ...
... For the mucolytic agent, several factors such as gastric acidity and hypersecretion of the gastric juice might be affecting the mucolytic activity [28]. Our study used sodium bicarbonate as a neutralizing agent, added with peppermint for antispasmodic action [31,33], in simethicone and NAC, compared to other groups of solutions. Our study showed visual enhancement of mucosal surface from upper gastrointestinal endoscopy than placebo and simethicone group. ...
Article
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Objectives Early cancer detection is crucial in improving the patients’ quality of life and upper gastrointestinal endoscopy (EGD) plays a key role in this detection. Many clearing mechanisms may be applied to create good endoscopic visualizations for the upper gastrointestinal tract using mucolytic agents, antifoaming agents, proteolytic enzymes and neutralizers. The aim of this study is to compare the effects of simethicone, N-acetylcysteine (NAC), sodium bicarbonate and peppermint as pre-medications for visualization of esophagogastroduodenoscopy (EGD). Methods This study was a single center prospective randomized controlled trial. The patients were randomly allocated to one of four treatment groups. Group A: water; Group B: water with simethicone; Group C: water with simethicone plus NAC 600 mg; Group D: water with simethicone, NAC, sodium bicarbonate and peppermint. Results A total of 128 patients were enrolled and evaluated in this study. Total visibility score (TVS) of Groups A, B, C, and D were 13.4 ± 1.86, 10.5 ± 1.45, 7.15 ± 0.98 and 6.4 ± 1.43, respectively. Group D showed lower TVS than other groups. The procedural durations of Groups C and D were significantly shorter than Group A. The volume of solution for mucosal cleansing of Groups C and D was significantly lower than Groups A and B. Conclusions The application of simethicone plus NAC is safe, improves endoscopic visualization and requires a minimal amount of mucosal cleansing solution. The addition of sodium bicarbonate and peppermint further improved visualization for the upper and lower gastric body. Thai Clinical Trials Registry (TCTR) with a reference number; TCTR20190501002.
... 10 Antiperistaltic and antispasmodic effects of peppermint oil or L-menthol have been studied in several trials. [11][12][13] Japanese researchers have confirmed that L-menthol could improve the stability of the visual field both in endoscopic diagnosis and treatment, including gastric endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), [14][15][16] thereby making it a useful antispasmodic drug for upper GI endoscopy. ...
Article
Full-text available
Objective: The topical antispasmodic agent L-menthol is commonly used for gastric peristalsis suppression during diagnostic upper gastrointestinal (GI) endoscopy. We evaluated the efficacy and safety of a single dose L-menthol solution in suppressing gastric peristalsis during upper GI endoscopy in Chinese patients. Methods: In this phase III, multicenter, randomized, double-blind, placebo-controlled study (ClinicalTrials.gov: NCT03263910), 220 patients scheduled to undergo upper GI endoscopy at five Chinese referral centers received a single dose of either 160 mg of L-menthol (n=109) or placebo (n=111). Both treatments were sprayed endoscopically on the gastric mucosa. An independent committee evaluated the degree of gastric peristalsis (peristaltic score: grade 1-5). Results: At baseline, the proportion of patients with grade 1 peristalsis (no peristalsis) did not differ between the groups. The proportion of patients with grade 1 peristalsis post-treatment was significantly higher in the L-menthol group (40.37%, 44/109) versus the placebo group (16.22%, 18/111; P<0.001); the difference between the groups was 24.15% (95% confidence interval: 12.67%-35.63%; P<0.001). In the L-menthol group, 61.47% of patients had grade 1 peristalsis after endoscopy versus 24.55% in the placebo group (P<0.001). The ease of intragastric examination correlated significantly with the grade of peristalsis. The incidence of adverse events was comparable between the groups (P=0.340). Conclusions: During upper GI endoscopy, a single dose of L-menthol solution (160 mg) sprayed on the gastric mucosa significantly attenuated gastric peristalsis versus placebo, thereby improving the visual stability without any safety concerns.
... Another study using esophageal manometry demonstrated that PMO did not affect the esophageal body and LES pressures in patients with diffuse esophageal spasm despite improvement of manometric findings (46). Given orally or topically sprayed PMO also decreased spasm of the sto mach (37,47). Some studies using manometry and/or barostat have demonstrated various effects on the gastric physiology such as decreased intragastric pressure, decreased gastric motility index, with no change in gastric accommodation (38,39,48). ...
Article
Full-text available
The pathophysiology of functional gastrointestinal disorders (FGIDs) is still unclear and various complex mechanisms have been suggested to be involved. In many cases, improvement of symptoms and quality of life (QoL) in patients with FGIDs is difficult to achieve with the single-targeted treatments alone and clinical application of these treatments can be challenging owing to the side effects. Herbal preparations as complementary and alternative medicine can control multiple treatment targets of FGIDs simultaneously and relatively safely. To date, many herbal ingredients and combination preparations have been proposed across different countries and together with a variety of traditional medicine. Among the herbal therapies that are comparatively considered to have an evidence base are iberogast (STW-5) and peppermint oil, which have been mainly studied and used in Europe, and rikkunshito and motilitone (DA-9701), which are extracted from natural substances in traditional medicine, are the focus of this review. These herbal medications have multi-target pharmacology similar to the etiology of FGIDs, such as altered intestinal sensory and motor function, inflammation, neurohormonal abnormality, and have displayed comparable efficacy and safety in controlled trials. To achieve the treatment goal of refractory FGIDs, extensive and high quality studies on the pharmacological mechanisms and clinical effects of these herbal medications as well as efforts to develop new promising herbal compounds are required.
... 44 During oesophagogastroduodenoscopy, investigators have found that peppermint oil/menthol sprayed on the mucosa decreased gastric peristalsis and increased pyloric ring diameter. 46,47 Topical mucosa application is potentially appealing because systemic exposure to menthol is much reduced compared with oral administration. 2,6,8 Peppermint oil sprayed on the mucosa during oesophagogastroduodenoscopy was found to decrease peak power frequency on electrogastrography. ...
Article
Background: Peppermint oil has been used for centuries as a treatment for gastrointestinal ailments. It has been shown to have several effects on gastrointestinal physiology relevant to clinical care and management. Aim: To review the literature on peppermint oil regarding its metabolism, effects on gastrointestinal physiology, clinical use and efficacy, and safety. Methods: We performed a PubMed literature search using the following terms individually or in combination: peppermint, peppermint oil, pharmacokinetics, menthol, oesophagus, stomach, small intestine, gallbladder, colon, transit, dyspepsia, nausea, abdominal pain, and irritable bowel syndrome. Full manuscripts evaluating peppermint oil that were published through 15 July 2017 were reviewed. When evaluating therapeutic indications, only randomised clinical trials were included. References from selected manuscripts were used if relevant. Results: It appears that peppermint oil may have several mechanisms of action including: smooth muscle relaxation (via calcium channel blockade or direct enteric nervous system effects); visceral sensitivity modulation (via transient receptor potential cation channels); anti-microbial effects; anti-inflammatory activity; modulation of psychosocial distress. Peppermint oil has been found to affect oesophageal, gastric, small bowel, gall-bladder, and colonic physiology. It has been used to facilitate completion of colonoscopy and endoscopic retrograde cholangiopancreatography. Placebo controlled studies support its use in irritable bowel syndrome, functional dyspepsia, childhood functional abdominal pain, and post-operative nausea. Few adverse effects have been reported in peppermint oil trials. Conclusion: Peppermint oil is a natural product which affects physiology throughout the gastrointestinal tract, has been used successfully for several clinical disorders, and appears to have a good safety profile.
Article
Importance: Esophagogastroduodenoscopy (EGD) is a common procedure used to examine upper gastrointestinal diseases. Although cimetropium bromide and other antispasmodic agents are commonly administered as premedication to inhibit peristalsis during EGD examination, there are few data regarding the benefits of cimetropium bromide for the detection of gastric neoplasms. Objective: To investigate the association between the use of cimetropium bromide as premedication and gastric neoplasm detection rates during EGD examination. Design, setting, and participants: This propensity score-matched retrospective cohort study included 67 683 participants who received EGD screening at the Health Promotion Center of Seoul St. Mary's Hospital, The Catholic University of Korea, from January 2, 2010, to June 30, 2017. Data were analyzed from April 1 to December 30, 2021. Exposures: Participants were divided into 2 groups: those who received cimetropium bromide before EGD examination (intervention group) and those who did not (control group). Main outcomes and measures: Gastric neoplasm detection rates. Results: Among 67 683 participants, the mean (SD) age was 48.6 (10.8) years, and 36 517 participants (54.0%) were male; all participants were Asian (a racially homogenous population). Of those, 28 280 participants (41.8%; mean [SD] age, 50.3 [10.6] years; 57.8% male) received cimetropium bromide, and 39 403 participants (58.2%; mean [SD] age, 47.4 [10.8] years; 51.2% male) did not. Propensity score matching based on confounding variables yielded 41 670 matched participants (20 835 pairs). Detected lesions included 52 dysplasias (0.12%), 40 early cancers (0.10%), 7 advanced cancers (0.02%), and 3 lymphomas (0.01%). Gastric neoplasm detection rates were significantly higher in the intervention group (63 participants [0.30%]) vs the control group (39 participants [0.19%]; P = .02). A significant difference in the combined detection rate of dysplasia and early gastric cancer was found between those in the intervention group (57 participants [0.27%]) vs the control group (35 participants [0.17%]; P = .02). For small gastric lesions (<1 cm), those who received cimetropium bromide had higher detection rates (24 participants [0.12%]) than those who did not (11 participants [0.05%]; P = .03). Lesions in the gastric body were detected significantly more often in the intervention group (34 participants [0.16%]) vs the control group (15 participants [0.07%]; P = .007). In multivariate analyses involving all 67 683 participants, the use of cimetropium bromide was more likely to detect gastric neoplasms compared with nonuse (odds ratio, 1.42; 95% CI, 1.04-1.95; P = .03). Conclusions and relevance: In this study, the use of cimetropium bromide as premedication was significantly associated with increased gastric neoplasm detection rates during EGD screening, and lesions in the gastric body were detected more frequently among those who received cimetropium bromide compared with those who did not. These findings suggest that cimetropium bromide may be considered as premedication before EGD examination among individuals with no contraindications.
Chapter
The peppermint plant (Mentha piperita) is a hybrid of water mint and spearmint. It is commonly used as an essential oil and is the first herb to try for abdominal pain related to irritable bowel syndrome. It has a relaxing effect on the smooth muscles of the GI tract. Peppermint may be beneficial for gastric hypermotility, nausea and vomiting, functional dyspepsia, irritable bowel syndrome, infantile colic, pruritus gravidarum, nipple fissures, tension headache, cognitive performance, hirsutism, and athletic performance. This chapter examines some of the scientific research conducted on peppermint, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several human studies of peppermint’s use in treating oral and dental, gastrointestinal, musculoskeletal, neurological, psychiatric, infectious, and oncological disorders. Finally, the chapter presents a list of peppermint’s active constituents, different Commonly Used Preparations and Dosage, and a section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
Article
Introduction: In randomized controlled trials, L-menthol inhibits gastrointestinal peristalsis during endoscopy. Our goal was to quantitatively synthesize the available evidence to evaluate the efficacy and safety of L-menthol for gastrointestinal endoscopy. Methods: We comprehensively searched for relevant studies published up to January 2020 in PubMed, EMBASE, Web of Science, and Cochrane Library. The main outcomes consisted of the proportion of no peristalsis, proportion of no or mild peristalsis, adenoma detection rate, and adverse events. Results: Eight randomized controlled trials analyzing 1,366 subjects were included. According to the pooled data, L-menthol significantly improved the proportion of no peristalsis (odds ratio [OR] = 6.51, 95% confidence interval [CI] = 4.94-8.57, P < 0.00001), and the proportion of no or mild peristalsis (OR = 7.89, 95% CI = 5.03-12.39, P < 0.00001) compared with the placebo, whereas it was not associated with an improvement in the adenoma detection rate (OR = 1.03, 95% CI = 0.54-1.99, P = 0.92). Adverse events did not differ significantly between the 2 groups (OR = 1.40, 95% CI = 0.75-2.59, P = 0.29). Discussion: The findings of this study support the use of L-menthol to suppress gastrointestinal peristalsis during endoscopic procedure.
Article
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More elderly patients now undergo gastrointestinal endoscopy following recent advances in endoscopic techniques. In this study, we conducted a high-risk survey of endoscopies in Japan, using a questionnaire administered prior to upper gastrointestinal tract endoscopy (UGITE), and identified anticholinergic agents and glucagon preparations as high-risk premedication. We also evaluated the cardiovascular effects of anticholinergic agents and glucagon through measurements of plasma levels of human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP). The subjects were 1480 patients who underwent UGITE. Nurses administered a pre-endoscopy questionnaire, questioning subjects regarding heart disease, hypertension, glaucoma, and urinary difficulties as risk factors for anticholinergic agents, and Diabetes mellitus as a risk factor for glucagon preparations. Evaluation of subjects divided into under 65 and over 65 age groups revealed that in subjects aged 65 and over, risk factors for anticholinergic agents were significantly more high than those for glucagon. Analysis of the cardiovascular effects of anticholinergic agents and glucagon, in the elderly patients showed that hANP levels were significantly higher following administration of anticholinergic agents, but the change was not significant for glucagon premedication. Taking a detailed history before UGITE with the aid of a questionnaire at the same time as informed consent is obtained, is extremely useful in terms of risk management and selection of the appropriate premedication.
Article
Gastric peristalsis and pyloric movement were observed by the gastric fibrescope GTF in 54 subjects either with normal gastric mucosa or mild to moderate atrophic gastritis. In a few instances, simultane-ous serial radiographs were also taken for comparison. The activity of gastric peristalsis was classified into the following 5 grades and their relation to pyloric movement was studied: Grade I Absence of peristalsis A. With patulous pylorus seen as a dark round hole; most common. B. With completely closed pylorus seen as a pinpoint; infrequent. C. With slight pyloric movement; extremely rare. Strong asterisklike contraction is never seen. Grade. II Mild peristalsis A. A round peristaltic wave is formed in the antrum, advancing slowly toward and disappearing immediately proximal to the pylorus (Fig.1-A). B. A non-propulsive contractile ring occurs and disappears repeatedly immediately proximal to the pylorus (Fig. 1-B). Grade III Moderate peristalsis Peristaltic wave is formed in the proximal antrum and advances distally, when the pylorus is open (Fig. 2-a); when the wave reaches the segment immedi-ately proximal to the pylorus, the pylorus starts closing, peristaltic wave contracts strongly to form a ring with radiating folds in the pyloric region (Fig. 2-b). The ring becomes more constrictive, and reaches the pylorus(Fig. 2-c). A complex, asterisklike contraction involving the pylorus is then formed and protrudes (Fig.2-d). Constriction dissolves from the centre enabling a glimpse of the closed pylorus (Fig. 2-e, f), followed by opening of the pylorus (Fig. 2-g) Grade IV Vigorous peristalsis The peristaltic wave is more marked and deeper, and moves with stronger antral constriction. The proximal side is elevated and longitudinal folds are seen over the surface of the wave (Fig. 3-a). With its distal movement luminal constriction and longit-udinal folds become more marked, to completely occlude the lumen (Fig. 3-b). When the peristaltic movement is vigorous, this constriction occurs con-siderably proximal to the pylorus, and the more active the peristalsis, the more proximally the constriction starts. The contraction ring protrudes proximally and the mucosa swells up through its centre and seemingly migrates centrif ugally (Fig. 3-c). Occasionally, duodenal juice regurgitates through it. The constriction dissolves gradually and the closed pylorus becomes visible through its opening (Fig. 3-d). The peripyloric area then becomes flattened usually with a shallow contraction ring remaining(Fig.3-e). Grade VV Markedly vigorous peristalsis The peristaltic wave is more prominent and stron-gly constricts the lumen already near the pars angularis with strong contraction of the entire antrum, but this type is extremely rare. Radiologically, when the peristaltic wave reaches, the proximal loop of circular muscle, a special muscular structure of the antrum, the onward movement is aborted, and the circular muscle loop contracts accompanying shortening of the lesser curve, followed by contractile movemnet of the whole prepyloric segment, a gastric emptying movement called "antral systol". The luminal constriction resembling the pylorus, as mentioned in Grade IV peristalsis, was considered by Schindler to be the pylorus itself or its vicinity, but, as it occurs considerably proximal to the pylorus, it cannot be the pylorus itself. While Fukuchi regarded it as representing the antral systol, , the swelling up of the mucosa through the constri-ction suggests a constant onward movement of peri-staltic wave, and may require an explanation diffe-rent from the so-called antral systol. The pyloric movement was usually associated with gastric peristalsis; in the absence of peristalsis or in the case of weak peristalsis, the pylorus was usually patulous. Occasionally, however, pyloric movement, though mild, was observed independent of peristalsis, suggesting some autonomy under certain circumstances. The peristalti
Article
An investigation of the mechanism of peppermint oil action was performed using isolated pharmacological preparations from guinea pig large intestine and patch clamp electrophysiology techniques on rabbit jejunum. Peppermint oil relaxed carbachol-contracted guinea pig taenia coli (IC50, 22.1 μg/mL) and inhibited spontaneous activity in the guinea pig colon (IC50, 25.9 μg/mL) and rabbit jejunum (IC50, 15.2 μg/mL). Peppermint oil markedly attenuated contractile responses in the guinea pig taenia coli to acetylcholine, histamine, 5-hydroxytryptamine, and substance P. Peppermint oil reduced contractions evoked by potassium depolarization and calcium contractions evoked in depolarizing Krebs solutions in taenia coli. Potential-dependent calcium currents recorded using the whole cell clamp configuration in rabbit jejunum smooth muscle cells were inhibited by peppermint oil in a concentration-dependent manner. Peppermint oil both reduced peak current amplitude and increased the rate of current decay. The effect of peppermint oil resembled that of the dihydropyridine calcium antagonists. It is concluded that peppermint oil relaxes gastrointestinal smooth muscle by reducing calcium influx.
Article
An investigation of the mechanism of peppermint oil action was performed using isolated pharmacological preparations from guinea pig large intestine and patch clamp electrophysiology techniques on rabbit jejunum. Peppermint oil relaxed carbachol-contracted guinea pig taenia coli (IC50, 22.1 micrograms/mL) and inhibited spontaneous activity in the guinea pig colon (IC50, 25.9 micrograms/mL) and rabbit jejunum (IC50, 15.2 micrograms/mL). Peppermint oil markedly attenuated contractile responses in the guinea pig taenia coli to acetylcholine, histamine, 5-hydroxytryptamine, and substance P. Peppermint oil reduced contractions evoked by potassium depolarization and calcium contractions evoked in depolarizing Krebs solutions in taenia coli. Potential-dependent calcium currents recorded using the whole cell clamp configuration in rabbit jejunum smooth muscle cells were inhibited by peppermint oil in a concentration-dependent manner. Peppermint oil both reduced peak current amplitude and increased the rate of current decay. The effect of peppermint oil resembled that of the dihydropyridine calcium antagonists. It is concluded that peppermint oil relaxes gastrointestinal smooth muscle by reducing calcium influx.
Article
Excretion of menthol (as glucuronide) from orally ingested peppermint oil contained in Colpermin was compared with oil contained in two soft gelatine capsules. Total 24 h urinary excretion of menthol was similar in the two formulations in healthy volunteers, but peak menthol excretion levels were lower and excretion delayed with Colpermin. Menthol excretion was reduced in ileostomy patients who took Colpermin and moderate amounts of unmetabolised menthol were recovered from the ileostomy effluent. This is consistent with Colpermin being a delayed-release form of peppermint oil.