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Efficacy of turmeric in the treatment of digestive disorders: A systematic review and meta-analysis protocol

Authors:

Abstract

Background Digestive disorders pose significant burdens to millions of people worldwide in terms of morbidity, mortality and healthcare costs. Turmeric has been traditionally used for conditions associated with the digestive system, and its therapeutic benefits were also confirmed in clinical studies. However, rigorous systematic review on this topic is severely limited. Our study aims to systematically review the therapeutic and adverse effects of turmeric and its compounds on digestive disorders, including dyspepsia, peptic ulcer, irritable bowel disease, Crohn’s disease, ulcerative colitis, and gastroesophageal reflux disease. Methods/Design This study will include both randomized controlled trials and non-randomized controlled trials assessing the efficacy and safety of turmeric or its compounds in comparison to a placebo or any other active interventions for digestive disorders without any restrictions on participant age or language of publication. The primary outcome is the proportion of patients that have experienced treatment success. Secondary outcomes are the prevalence of an individual symptom of digestive disorders, the proportion of patients who experienced relapse, the number of physician visits/hospitalization due to digestive disorders, health-related quality of life and the proportion of patients who experienced adverse events. Relevant studies will be identified through MEDLINE, EMBASE, AMED, Dissertations & Theses Database and the Cochrane Central Register of Control Trials from their inception to August 31, 2013. In addition, grey literature such as information published on drug regulatory agencies websites and abstracts/proceedings from conferences will also be reviewed. A calibration exercise will be conducted in a process of study screening, whereby two reviewers will independently screen titles and abstracts from the literature search. Any conflicts will be resolved through a subsequent team discussion. The same process will be adopted in data abstraction and methodological quality appraisal by the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. We will describe study and patient characteristics, risk of bias/methodological quality results, and outcomes of the included studies. If we have sufficient data and homogeneity, a random effects meta-analysis will be performed. Discussion Our results will help patients and healthcare practitioners to make informed decisions when considering turmeric as an alternative therapy for digestive disorders. Trial registration PROSPERO registry number: CRD42013005739.
P R O T O C O L Open Access
Efficacy of turmeric in the treatment of digestive
disorders: a systematic review and meta-analysis
protocol
Kednapa Thavorn
1*
, Muhammad M Mamdani
1,2,3,4
and Sharon E Straus
1,5
Abstract
Background: Digestive disorders pose significant burdens to millions of people worldwide in terms of morbidity,
mortality and healthcare costs. Turmeric has been traditionally used for conditions associated with the digestive
system, and its therapeutic benefits were also confirmed in clinical studies. However, rigorous systematic review on
this topic is severely limited. Our study aims to systematically review the therapeutic and adverse effects of turmeric
and its compounds on digestive disorders, including dyspepsia, peptic ulcer, irritable bowel disease, Crohns disease,
ulcerative colitis, and gastroesophageal reflux disease.
Methods/Design: This study will include both randomized controlled trials and non-randomized controlled trials
assessing the efficacy and safety of turmeric or its compounds in comparison to a placebo or any other active
interventions for digestive disorders without any restrictions on participant age or language of publication. The
primary outcome is the proportion of patients that have experienced treatment success. Secondary outcomes are
the prevalence of an individual symptom of digestive disorders, the proportion of patients who experienced relapse,
the number of physician visits/hospitalization due to digestive disorders, health-related quality of life and the
proportion of patients who experienced adverse events. Relevant studies will be identified through MEDLINE,
EMBASE, AMED, Dissertations & Theses Database and the Cochrane Central Register of Control Trials from their
inception to August 31, 2013. In addition, grey literature such as information published on drug regulatory agencies
websites and abstracts/proceedings from conferences will also be reviewed. A calibration exercise will be
conducted in a process of study screening, whereby two reviewers will independently screen titles and abstracts
from the literature search. Any conflicts will be resolved through a subsequent team discussion. The same process
will be adopted in data abstraction and methodological quality appraisal by the Cochrane Risk of Bias Tool and the
Newcastle-Ottawa Scale. We will describe study and patient characteristics, risk of bias/methodological quality
results, and outcomes of the included studies. If we have sufficient data and homogeneity, a random effects
meta-analysis will be performed.
Discussion: Our results will help patients and healthcare practitioners to make informed decisions when
considering turmeric as an alternative therapy for digestive disorders.
Trial registration: PROSPERO registry number: CRD42013005739.
* Correspondence: kednapa.thavorn@alum.utoronto.ca
1
Li Ka Shing Knowledge Institute, St. Michaels Hospital, M5B 1W8 Toronto,
ON, Canada
Full list of author information is available at the end of the article
© 2014 Thavorn et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Thavorn et al. Systematic Reviews 2014, 3:71
http://www.systematicreviewsjournal.com/content/3/1/71
Background
Digestive disorders, including dyspepsia, peptic ulcer dis-
ease, irritable bowel disease (IBS), inflammatory bowel dis-
ease (IBD), and gastroesophageal reflux disease (GERD),
affect millions of people worldwide and place a highly sig-
nificant economic burden on the healthcare systems [1,2].
In the United States, the total cost of digestive disorders
was approximately $142 billion in 2009 [3], and digestive
cancers ($24.1 billion), liver disease ($13.1 billion), and
GERD ($12.6 billion) were identified as the three most
costly conditions. In the United Kingdom, total cost attrib-
utable to gastrointestinal (GI) diseases was approximately
£8 billion in 1997 [4].
Digestive disorders are conventionally treated with
drugs and surgery, as well as psychological and behav-
ioral therapy. Recently, alternative or complementary
medicines, such as acupuncture, and herbal/dietary ther-
apy, have become increasingly popular in persons with
digestive disorders, especially when conventional therap-
ies fail to improve their symptoms [5]. A survey of 539
patients attending an outpatient clinic in Spain showed
that nearly two-thirds (61.6%) of patients with digestive
disorders had used herbal therapies in the past year, and
patients who were female, had a university education, or
were diagnosed with lower GI disorders were found to
be more frequent users of herbal therapies. Moreover,
approximately 80% of these users were satisfied with the
results these therapies yielded [6].
Turmeric is traditionally used as a herbal remedy for a
variety of diseases in India and China and as an over-the-
counter supplement worldwide [7]. Over the years,
pre-clinical and clinical studies have shown numerous
potential therapeutic activities, including anti-inflammatory
[8], antioxidant [9], antimicrobial [10], antiplatelet [11],
and anticancer effects [12], as well as choleretic and car-
minative actions [13]. In pre-clinical trials, turmeric was
shown to potentially protect the GI tract through its
anti-inflammatory effect. It also demonstrated its ability
to increase the secretion of gastrin, secretin, and bicar-
bonate, gastric wall mucus and pancreatic enzyme [7],
while inhibiting intestinal spasms and ulcer formation
caused by stress, alcohol, indomethacin, pyloric ligation,
and reserpine [14]. Turmeric was found to effectively
improve dyspeptic symptoms in patients with dyspepsia,
as well as maintain remission in patients with ulcerative
colitis (UC); however, it did not significantly improve
IBS-related outcomes. In particular, a randomized con-
trolled trial (RCT) was conducted in 116 patients with
dyspeptic complaints (such as abdominal pain, epigas-
tric discomfort, flatulence or belching) [15]. The study
findings indicate that after 7 days, 87% of the turmeric
group experienced symptom relief from dyspepsia com-
pared to 53% of the placebo group (P= 0.003). Another
RCT was conducted to assess the effect of curcumin
(the main active ingredient of turmeric) in 82 patients
with UC [16]. These patients were randomly allocated
to receive 1 g curcumin twice daily in addition to sulfa-
salazine or mesalamine or placebo as well as sulfasalazine
or mesalamine for 6 months. At the end of the study
period, fewer patients in the curcumin group experienced
relapse compared to the control group (4.7% vs 20.5%,
P= 0.038). In contrast, in a RCT of 106 patients with
IBS, a consumption of 60 mg turmeric daily was found
to have no significant therapeutic benefit over placebo
in decreasing IBS-related pain and distention scores,
other IBS symptoms, and psychological stress due to
IBS [17].
To date, only one methodologically rigorous systematic
review of the effects of turmeric (AMSTAR [18] score = 6)
was conducted [19]. In this study, the authors reviewed
the efficacy and safety of turmeric for maintenance remis-
sion in patients with UC. The findings suggest that, of 216
identified studies, only one study met the inclusion cri-
teria, and this included study had a low risk of bias. This
systematic review concluded that curcumin was a safe and
effective therapy for maintenance of remission in patients
with UC, in particular when supplement by mesalamine
or sulfalazine.
Given the paucity of work on the therapeutic role of
turmeric, we propose to complete a systematic review to
determine the efficacy and safety of turmeric and its
compounds in patients living with digestive disorders,
including dyspepsia, peptic ulcer, IBS, IBD (Crohns dis-
easeandUC),andGERD.Ourspecificreviewquestions
are: 1) in patients with digestive disorders (that is, dys-
pepsia,pepticulcer,IBS,IBD,orGERD),whatarethe
effects of turmeric and its compounds on the treatment
success, relapse rates, physician and hospitalization
visits due to digestive disorders, and health-related quality
of life; and 2) what adverse events are associated with
turmeric and its compounds?
Methods/Design
The systematic review protocol was designed based on the
guidance from the PRISMA-P (Preferred Reporting Items
for Systematic reviews and Meta-analyses Protocol) [20].
Eligibility criteria
We will include studies of participants of any age, in-
cluding children (<18 years old), and adults (18 years
old), who were diagnosed with the following digestive
disorders: dyspepsia, peptic ulcer, IBS, IBD (including
Crohns disease and UC), and GERD. Dyspepsia is a
group of symptoms that may include post-prandial full-
ness or an unpleasant sensation, such as prolonged per-
sistence of food in the stomach, a feeling that the
stomach is overfilled soon after starting to eat, epigastric
pain, and epigastric burning [21]. A peptic ulcer is a
Thavorn et al. Systematic Reviews 2014, 3:71 Page 2 of 6
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defect in the lining of the stomach (gastric ulcer) or the
first part of the small intestine (duodenal ulcer) [22].
Diagnosis is based on endoscopy by gastroenterologists.
IBS is a functional GI disorder or a condition caused by
changes in GI function. The most common symptoms of
IBS are abdominal pain or discomfort, abdominal cramp-
ing, typically accompanied by diarrhea and/or constipa-
tion. Diagnosis is based on the Rome III diagnostic criteria
for IBS [23]. IBD can be categorized into two diseases:
Crohns disease and UC. Examples of the symptoms con-
sist of diarrhea, constipation, pain or rectal bleeding with
bowel movement, as well as abdominal pain/cramping.
The condition is typically diagnosed by colonoscopy.
GERD is defined as a collection of symptoms or tissue
damage as a result of reflux of gastric contents into the
esophagus [24]. Common symptoms include epigastric
pain/discomfort, heartburn and regurgitation. GERD is
usually diagnosed based on the symptoms and endos-
copymayberequiredinsomecases.
In this review, we will include studies in which patients
in the treatment group received turmeric at any dosage
regimen, formulation, and duration compared to a control
group that received a placebo, no treatment, or any other
active interventions for their GI condition. We will include
experimental studies (RCTs, quasi-RCTs, controlled
clinical trials), quasi-experimental studies (interrupted
time series, controlled before after studies), and observa-
tional studies (cohort and casecontrol studies). We chose
to include non-RCTs and observational studies because, in
our scoping searches, we found few RCTs that examined
the efficacy and safety of turmeric in patients with di-
gestive disorders.
The primary outcome of interest is the proportion of
patients who experienced treatment success (as defined
by included studies, shown in Table 1). Secondary out-
comes consist of prevalence of an individual symptom as-
sociated with digestive disorders (such as abdominal pain,
epigastric pain), proportion of patients who experienced
relapse (as defined by the included studies), the number of
physician visits due to digestive disorders, the number of
hospitalization visits due to digestive disorders, disease-
specific quality of life, general health-related quality of life,
and the proportion of patients who experienced adverse
events.
This systematic review will not impose any restrictions
on publication status, time period, language of dissemin-
ation, and duration of follow-up. We will exclude animal
studies.
Information sources
We will search the following electronic databases from
inceptionto31August2013usingmedicalsubject
headings (MeSH) and text words related to turmeric
and digestive disorders: MEDLINE, EMBASE, AMED,
ProQuest Dissertations & Theses Database, and the
Cochrane Central Register of Control Trials using a
search strategy (Additional file 1: Appendix 1) drafted
by an experienced librarian. We will also search for grey
literature through drug regulatory agencies (that is, the
National Center for Complementary and Alternative Medi-
cine (NCCAM), European Medicines Agency (EMEA)),
Comprehensive Database of Natural Medicines, trial
registry website (www.clinicaltrials.gov), and abstracts/
proceedings from conferences, such as the World Con-
gress of Gastroenterology, the International Society for
Pharmacoeconomics and Outcomes Annual International
Meeting, and the Annual Cochrane Colloquium. The ref-
erence lists of the studies included in the review will also
be searched. Moreover, experts in the field will be con-
tacted to identify relevant studies.
Study selection process
Study selection process consists of three levels. For level 1,
titles and abstracts identified from the literature search
will be screened independently by the review team. We
will conduct a calibration exercise using a random sample
Table 1 Examples of treatment success of gastrointestinal disorders
Gastrointestinal disorder Treatment success
Dyspepsia Improvement in dyspepsia clinical scores, such as a dyspepsia score [25,26], the Global Overall Severity score [27]
Peptic ulcer Complete healing of the ulcer as observed from endoscopy [28]; or
Presence of negative tests for Helicobacter pylori 4 weeks or longer after the end of therapy [29]
IBS Improvement in IBS clinical scores, such as:
IBS-related symptom score [30]
Functional Bowel Disorder Severity Index [31]
IBS Severity Scoring System [32]
IBD - Crohns disease Improvement in the Crohn's Disease Activity Index [33]
IBD - ulcerative colitis Improvement in the clinical scores, such as Mayo Clinic Score [34], Modified Mayo Disease Activity Index [35]
GERD Improvement in clinical scores, such as GERD score [36], Gastroesophageal Reflux Disease Activity Index [37]
GERD, gastroesophageal reflux disease; IBD, inflammatory bowel disease; IBS, irritable bowel disease.
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of 50 citations that will be screened by all team members
independently to identify those that meet eligibility cri-
teria. Inter-rater agreement for study inclusion will be cal-
culated using the percent agreement, whereby the study
screening process will continue only if >90% of agreement
is observed. If there is any discrepancy (that is, <90%
agreement), it will be resolved through a team discussion.
A second exercise with another 50 articles will be con-
ducted if poor agreement is noted. A similar process will
be repeated for screening the full-text of the relevant arti-
cles (level 2) to determine if they meet eligibility criteria.
For the data abstraction process (level 3), a random sam-
ple of five included studies will be piloted. Similarly, the
abstraction process will start only if the percent agreement
is greater than 90%. In this phase, the reviewers will inde-
pendently extract data, including study characteristics
(study design, year of study conduct, duration of the study,
setting, sample size, country of study conduct), patient
characteristics (number of patients, mean age and stand-
ard deviation, type of digestive disorders, severity of digest-
ive disorders, place of residences (hospital or community
settings), history of digestive disorders, use of gastrointes-
tinal drugs, use of non-steroidal anti-inflammatory drugs
(NSAIDs), and co-morbidities), description of intervention
and comparators (number of arms, sample size for each
group, turmeric species, type of turmeric preparations,
dose, duration of use, frequency of use), and study out-
comes (proportion of patients reporting treatment success,
prevalence of individual symptom associated with digestive
disorders, proportion of patients who experienced relapse,
the number of physician and hospitalization visits due
to digestive disorders, disease-specific quality of life,
and general health-related quality of life).
Methodological quality/risk of bias appraisal
Assessment of the risk of bias pertaining to the included
studies will be performed independently by all reviewers,
whereby the risk of bias tools will be used in accordance
with the study design. Risk of bias for RCTs as well as
non-RCTs, such as controlled before-and-after and
interrupted time series studies, will be assessed using the
nine-item checklist suggested by the Effective Practice
and Organization of Care group [38]. This tool assesses
the following domains of bias: sequence generation, alloca-
tion concealment, baseline outcome measurement, base-
line characteristic measurement, incompleteness outcome
data, blinding of outcome assessment, contamination,
selective outcome reporting, and other types of bias.
For observational studies, we will appraise the methodo-
logical quality using the nine-item Newcastle-Ottawa
Scale [39]. The quality of casecontrol studies will be
assessed according to adequate definition of cases, repre-
sentativeness of cases, selection of controls, definition of
controls, comparability of cases and controls on the basis
of the design or analysis, exposure assessment, same
method of ascertainment for all subjects, and non-
response rate. The quality of cohort studies will be
assessed on the basis of representativeness of the ex-
posed cohort, selection of the unexposed cohort, ascer-
tainment of exposure, demonstration that outcome of
interest was not presented at start of study, compar-
ability of cohorts on the basis of the design or analysis,
outcome assessment, sufficient follow-up duration to
capture outcomes, adequacy of follow-up of cohorts.
Disagreement will be resolved by a team discussion. To
ascertain that we have sufficient power to distinguish
chance from real symmetry, the potential for publication
bias will be examined using funnel plots only when at least
10 studies are included in the meta-analysis [40].
Synthesis of included studies
We will first describe study characteristics, patient charac-
teristics, risk of bias/methodological quality results, and
summarize the reported outcomes of the included studies.
If the data abstraction process yields sufficient data (that
is, at least three studies), and the included studies are ad-
equately similar in terms of participants, type of digestive
disorders, interventions, outcome measures, study designs,
and risk of bias, each specified review outcome will be
pooled using a random-effect meta-analysis. Summary
statistics for continuous outcomes will be expressed as
mean difference and standardized mean difference with
95% CIs. Mean difference will be estimated if the in-
cluded studies reported the outcomes using the same
scale. Standardized mean difference will be estimated if
the included studies presented outcomes using different
scales - for example, the use of Functional Bowel Disorder
Severity Index and IBS Severity Scoring System to repre-
sent the severity of IBS. For dichotomous data, summary
statistics will be expressed as a risk ratio with 95% CI for
ease of interpretation. These analyses will be performed
using SAS version 9.3 (SAS Institute, Cary NC).
Clinical heterogeneity or variability in the participants,
the types of outcome measurements, and intervention
characteristics will be assessed by clinical experts in the
field and a research team. Methodological heterogeneity
of the included studies will be assessed by a team discus-
sion, while heterogeneity of the summary treatment effects
(statistical heterogeneity) will be evaluated using I
2
statis-
tics. If extensive clinical or methodological heterogeneity
is observed, or substantial statistical heterogeneity (that is,
I
2
statistic 60%) is identified, we will attempt to explain
the underlying causes of heterogeneity. In particular, if the
number of included studies permit, we will undertake sub-
group analyses based on: 1) age (18 years old vs >18 years
old); 2) dose of turmeric; 3) concomitant use of NSAIDs;
4) place of residence (hospitals vs community settings);
and 5) turmeric species (such as Curcuma domestica,
Thavorn et al. Systematic Reviews 2014, 3:71 Page 4 of 6
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Curcuma longa). If a pre-specified subgroup analysis is
not feasible due to a small number of included studies, we
will use narrative synthesis and present outcomes by type
of GI condition, type of intervention, study design, and
type of outcome.
In cases of missing data, we plan to contact investigators
or study sponsors. A series of sensitivity analyses will
be also conducted to assess the impact of the following
factors on the main finding: dosage and formulation of
turmeric, patient attrition rate, and type of study.
Discussion
This systematic review has significant clinical implica-
tion. In particular, if the gastroprotective effect of tur-
meric is confirmed, turmeric and its compounds should
be considered as a promising alternative for patients
who suffer from digestive disorders because it is safe
[41], inexpensive, and ubiquitously available. In contrast,
if gastroprotective effects of turmeric cannot be estab-
lished, this evidence would be useful in enhancing the
patientsunderstanding of the limitations of this com-
monly used therapy. Thus, it could guard them against
the false claims and advertisements of turmeric product
manufacturers.
To ensure that our findings have clinical impact on
patients with digestive disorders, we plan to disseminate
our findings by presenting at relevant conferences, pub-
lishing in a peer-reviewed journal as well as newspapers,
newsletters, and websites of interested organizations.
Additional file
Additional file 1: Appendix 1. Draft search strategy.
Abbreviations
GERD: gastroesophageal reflux disease; GI: gastrointestinal; IBD: inflammatory
bowel disease; IBS: irritable bowel disease; NSAID: non-steroidal
anti-inflammatory drug; RCT: randomized controlled trial; UC: ulcerative
colitis.
Competing interests
The authors declare that they have no competing interests.
Authorscontributions
KT formulated the research question and registered the protocol with the
PROSPERO database. KT, MMM, and SES designed the study. MMM obtained
the funding for the study. All authors drafted, revised and approved the final
protocol.
Acknowledgements
This project is funded by the Li Ka Shing Knowledge Institute of St. Michaels
Hospital. KT is supported by the Li Ka Shing Post-doctoral Fellowship
Program. We thank Laure Perrier for conducting the literature search.
Author details
1
Li Ka Shing Knowledge Institute, St. Michaels Hospital, M5B 1W8 Toronto,
ON, Canada.
2
Institute for Clinical Evaluative Sciences, M4N 3M5 Toronto, ON,
Canada.
3
Institute of Health Policy, Management, and Evaluation, University
of Toronto, M5T 3M6 Toronto, ON, Canada.
4
Leslie Dan Faculty of Pharmacy,
University of Toronto, M5S 3M2 Toronto, ON, Canada.
5
Department of
Geriatric Medicine, University of Toronto, M5S 1A8 Toronto, ON, Canada.
Received: 19 September 2013 Accepted: 10 June 2014
Published: 28 June 2014
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Cite this article as: Thavorn et al.:Efficacy of turmeric in the treatment
of digestive disorders: a systematic review and meta-analysis protocol.
Systematic Reviews 2014 3:71.
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... Herbal medicine is increasingly being used in clinical practice worldwide for various indications [1][2][3]. Herbal products have been considered safe as they have been used for a long time in the past decades. Due to their complex chemical constituents, however, potential adverse interactions are the major concern when they are concomitantly administered with other herbal or modern medicines. ...
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Atractylodes lancea (Thunb.) DC. ( A . lancea : AL) is a promising candidate for the treatment of cholangiocarcinoma (bile duct cancer). The study investigated (i) the propensity of capsule formulation of the standardized extract of AL (formulated AL) to modulate mRNA and protein expression and activities of CYP1A2 and CYP3A1 in rats after long- and short-term exposure, (ii) the pharmacokinetics of atractylodin (ATD: active constituent) after long-term administration of formulated AL, and (iii) the biodistribution of atractylodin-loaded polylactic-co-glycolic acid (ATD-PLGA-NPs) in mice. To investigate CYP1A2 and CYP3A1 modulatory activities following long-term exposure, rats of both genders received oral doses of the formulated AL at 1,000 (low dose), 3,000 (medium dose), and 5,000 (high dose) mg/kg body weight daily for 12 months. For short-term effects, male rats were orally administered the formulated AL at the dose of 5,000 mg/kg body weight daily for 1, 7, 14 and 21 days. The pharmacokinetic study was conducted in male rats after administration of the formulated AL at the dose of 5,000 mg/kg body weight daily for 9 months. The biodistribution study was conducted in a male mouse receiving ATD-PLGA-NPs at the equivalent dose to ATD of 100 mg/kg body weight. The high dose of formulated AL produced an inducing effect on CYP1A2 but an inhibitory effect on CYP3A1 activities in male rats. The low dose, however, did not inhibit or induce the activities of both enzymes in male and female rats. ATD reached maximum plasma concentration (C max ) of 359.73 ng/mL at 3 h (t max ). Mean residence time (MRT) and terminal phase elimination half-life (t 1/2z ) were 3.03 and 0.56 h, respectively. The extent of biodistribution of ATD in mouse livers receiving ATD-PLGA-NPs was 5-fold of that receiving free ATD. Clinical use of low-dose AL should be considered to avoid potential herb-drug interactions after long-term use. ATD-PLGA-NPs is a potential drug delivery system for cholangiocarcinoma treatment.
... Curcumin, a secondary metabolite of the plant turmeric, is a common food ingredient in India (Zaidi, 2016). The turmeric plant is used in the traditional Indian medicine system, Ayurveda, to treat gastrointestinal diseases including gastric dyspepsia (Thavorn et al., 2014;Zaidi, 2016). Importantly, curcumin modulates several biological functions, including apoptosis, cell proliferation, and immune responses (Ireson et al., 2002). ...
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... Over the years, ample data through clinical and experimental studies have been documented of turmeric extract (Kalpravidh et al. 2010;Lim et al. 2011;Aditya et al. 2012;Panahi et al. 2014). The therapeutic benefits of curcumin include anti-inflammatory, antioxidant, anticancer actions and treatment of digestive disorders (Jurenka 2009;Anand et al. 2008;Thavorn et al. 2014). Nevertheless, curcumin is a therapeutically potent molecule, its poor bioavailability and chemical instability limits the effective use of it (Anand Page 2 of 10 Sudeep et al. ...
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... In Storehouse of Medicaments (a pharmacopoeia by Mohammad Hosein Aghili Shirazi; 1670-1747 C.E.), a complete description of 1,700 monographs, including Pistacia lentiscus, Phyllanthus emblica, Terminalia belerica, and Terminalia chebula, was provided [16]. The World Health Organization has reported that the use of herbal remedies has increased twofold to threefold compared to conventional drugs worldwide [17,18]. In the primary healthcare system in developing countries, about 80% of patients continue to use traditional medicine. ...
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Background: Pyrosis and regurgitation are the cardinal symptoms of gastroesophageal reflux disease. Several herbs have been used for treating gastrointestinal disorders worldwide. This systematic review was conducted to investigate the effects of medicinal herbs on gastroesophageal reflux disease and adverse events. Methods: MEDLINE (via PubMed; The United States National Library of Medicine, USA), Scopus, ScienceDirect, Cochrane Central Register of Controlled Trials, Web of Science, Magiran, and Scientific Information Database were systematically searched for human studies, without a time frame, using medical subject heading terms such as “gastroesophageal reflux disease”, “reflux”, “esophagitis” and “herbs”. Manual searches completed the electronic searches. Results: Thirteen randomized controlled trials were identified, including 1,164 participants from 1,509 publications. In comparing herbal medicine to placebo, there were no significant differences in terms of heartburn (P = 0.23 and 0.48), epigastric or abdominal pain (P = 0.35), reflux syndrome (P = 0.12), and effective rate (P = 0.60), but there was a significant difference in terms of acid regurgitation (P = 0.01). In comparing herbal medicine to drugs, there was a significant difference in terms of effective rate (P = 0.001), and there was one trial that reported a significant difference in terms of epigastric pain (P = 0.00001). Also, in comparing herbal medicine to drugs, there were no significant differences in terms of acid regurgitation (P = 0.39). Conclusion: This meta-analysis showed that herbal medicines are effective in treating gastroesophageal reflux disease. Further standardized researches with a large-scale, multicenter, and rigorous design are needed. Keywords: Herbal medicine, Gastroesophageal reflux disease, Randomized controlled trial, Acid regurgitation, Effective rate, Epigastric pain
... Turmeric is traditionally used as an herbal remedy for a variety of diseases in India and China and as an over-the counter supplement worldwide. 1 Turmeric is a rhizomatous herbaceous perennial plant (Curcuma longa) of the ginger family (Fig. 1). The chemically active component of turmeric, curcuminoids, also called diferuloylmethane (Fig. 2), is the natural hydrophobic polyphenol. 2 The primary active constituent of turmeric, which is responsible for its vibrant yellow color, is curcumin, which was first identified in 1910 by Lampe and Milobedzka. ...
Chapter
Turmeric, a golden spice, and cinnamon have a long history of not only as a principal spice in Asian cuisine, but most importantly as medicinal purposes as well. Traditionally, these spices have been used as herbal remedy for variety of diseases related to skin, aches, pulmonary, liver disorder, and gastrointestinal problems such as stomach cramps, diarrhea, constipation, cough, and indigestion. Turmeric and cinnamon are also known as natural agents which modulate the immune system. Furthermore, modern science has shown that these spices and their major chemical constituents, curcumin and cinnamaldehyde, respectively, regulate many biological processes including enhanced metabolism process. Even to date, turmeric and cinnamon still become subject of interest to many medicinal chemists for their wide range of pharmacological properties such as antiinflammatory, antidiabetic, anticancer, antiangiogenesis, antioxidant, as well as anti-viral. This chapter summarizes the effects of turmeric and cinnamon on the digestion, metabolism, and immune system. In the nutshell, both are wonders spices that possess amazing health benefits that are absolutely needed by everyone.
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Chapter
Since the 1960s, laryngopharyngeal reflux (LPR) has been hypothesized as reflux of gastric contents through the upper and lower esophageal sphincter (LES) into the larynx and pharynx (Francis and Vaezi, Clin Gastroenterol Hepatol, 13:1560–1566, 2015). A lax LES or increased pressure through a normal LES has often been considered a factor in LPR, resulting in reflux of acidic or nonacidic nature. Concurrent gastroesophageal reflux disease (GERD) is usually not present. This was first noted by Koufman with 81% of pH-documented LPR patients showing normal esophagoscopy (Koufman, Laryngoscope, 101:1–78, 1991). General symptoms of LPR include hoarseness of the voice, sore throat, chronic cough, globus sensation, dysphagia, sinusitis, and symptoms of asthma. LPR diagnosis via laryngoscopy is subjective and controversial at best with concern for overdiagnosis. Based on its assumed etiology, LPR treatment is based largely on the same standard of care used for GERD with very little in the way of prevention or LPR-specific treatments.
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SummaryA global measurement of Crohn's disease activity, comprising clinical, endoscopic, biochemical and pathological features is not available yet and perhaps is unobtainable. In this review we analyse the most used and validated clinical indices (Crohn's Disease Activity Index [CDAI], Perianal Disease Activity Index [PDAI], fistula drainage assessment), quality of life scores (Inflammatory Bowel Disease Questionnaire [IBDQ]), sub-clinical markers (C-reactive protein, faecal calprotectin, intestinal permeability) and endoscopic indices (Crohn's Disease Endoscopic Index of Severity [CDEIS]/Simple Endoscopic Score for Crohn's Disease [SES-CD], Rutgeeerts' score for postsurgical recurrence). We also review the main advantages and disadvantages of each of these scoring systems. All these indices are rather complex and time-consuming, therefore their use is limited to clinical trials. In everyday clinical practice most gastroenterologists rely on their global clinical judgement, which is less reproducible, but simpler for decision-making.
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In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0–100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.