CC BY 4.0 · Z Gastroenterol 2023; 61(03): 257-267
DOI: 10.1055/a-1823-1333
Originalarbeit

Menthacarin for long-term treatment of functional dyspepsia – Results from a clinical trial follow-up

Menthacarin zur Behandlung der funktionellen Dyspepsie – Ergebnisse eines Langzeit-Follow-ups
Martin Storr
1   Zentrum für Endoskopie, Starnberg, Germany und Medizinische Klinik und Poliklinik II, Klinikum Großhadern, München, Germany
,
Berenike Stracke
2   Global Medical Affairs, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
› Author Affiliations
Supported by: Dr. Willmar Schwabe GmbH & Co. KG

Abstract

Background Menthacarin was shown to be effective and safe in clinical trials in patients with functional dyspepsia (FD). Long-term treatment results have not been reported yet.

Methods An open-label, 11-month follow-up (FU) was offered to FD patients who had undergone treatment with Menthacarin (1 gastro-resistant capsule b.i.d. vs. placebo (PL)) in a 4-week, double-blind, clinical trial. During FU, all patients (former verum and PL) were treated with 1 gastro-resistant capsule Menthacarin b.i.d. Main outcomes were the changes in pain intensity and severity of sensation of pressure, heaviness, and fullness from original baseline and global improvement.

Results 70 patients were included in the analyses (former Menthacarin group: 36, former PL group: 34). At the end of the PL-controlled study phase, all 3 main efficacy variables were statistically significantly improved in the Menthacarin group compared to PL. In the FU phase, former PL patients started to improve under Menthacarin treatment towards the outcomes seen in the former Menthacarin group (alignment at approximately 6 months), while former Menthacarin patients showed sustained or even continuously improved outcomes by month 12. At study end, more than 90% of patients were “much or very much improved" in both groups. Menthacarin treatment was well tolerated.

Conclusions The favorable effects seen in the FU period suggest that Menthacarin is a valuable treatment option in FD patients who require symptomatic treatment also in the longer term for up to 12 months.

Zusammenfassung

Hintergrund Menthacarin hat sich in klinischen Studien bei Patienten mit funktioneller Dyspepsie (FD) als wirksam und sicher erwiesen. Langzeitergebnisse einer Behandlung wurden bisher nicht berichtet.

Methodik FD-Patienten, die in einer 4-wöchigen klinischen Doppelblindstudie mit Menthacarin (1 gastroresistente Kapsel b.i.d. vs. Placebo [PL]) behandelt worden waren, wurde ein offenes, 11-monatiges Follow-up (FU) angeboten. Während des FU erhielten alle Patienten (sowohl ehemalige Verum- als auch PL-Patienten) 1 magensaftresistente Kapsel Menthacarin b.i.d. Wichtigste Zielparameter waren die Veränderung der Schmerzintensität und des Schweregrads des Druck-, Schwere- und Völlegefühls sowie die globale Verbesserung.

Ergebnisse Die Analyse umfasste insgesamt 70 Patienten (36 ehemals Menthacarin, 34 ehemals PL). Alle 3 Hauptwirksamkeitsvariablen waren in der Menthacarin-Gruppe am Ende der PL-kontrollierten Studienphase im Vergleich zu PL statistisch signifikant verbessert. In der FU-Phase begannen sich die vormaligen PL-Patienten unter Menthacarin-Behandlung zu verbessern und sich den Ergebnissen der vormaligen Menthacarin-Gruppe anzunähern (Angleichung nach etwa 6 Monaten), während die letztere Gruppe bis Monat 12 eine anhaltende oder fortschreitende Besserung zeigte. Am Studienende waren über 90% der Patienten beider Gruppen stark oder sehr stark verbessert. Die Menthacarin-Behandlung war gut verträglich.

Schlussfolgerungen Die in der FU-Periode beobachteten günstigen Effekte legen nahe, dass Menthacarin eine wertvolle Therapieoption bei FD-Patienten ist, welche eine symptomatische Behandlung benötigen, auch bei einer längerfristigen Einnahme über bis zu 12 Monate.



Publication History

Received: 23 September 2021

Accepted after revision: 15 March 2022

Article published online:
13 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Moayyedi PM, Lacy BE, Andrews CN. et al. ACG and CAG Clinical Guideline: Management of Dyspepsia. American Journal of Gastroenterology 2017; 112: 988-1013
  • 2 Talley NJ, Stanghellini V, Heading RC. et al. Functional gastroduodenal disorders. Gut 1999; 45 (Suppl. 02) Ii37-li42
  • 3 Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology 2016;
  • 4 Stanghellini V, Cogliandro R. Review article: adherence to Rome criteria in therapeutic trials in functional dyspepsia. Aliment Pharmacol Ther 2014; 40: 435-466
  • 5 Stanghellini V, Chan FK, Hasler WL. et al. Gastroduodenal Disorders. Gastroenterology 2016; 150: 1380-1392
  • 6 Stanghellini V. Functional Dyspepsia and Irritable Bowel Syndrome: Beyond Rome IV. Dig Dis 2017; 35: 14-17
  • 7 Ford AC, Mahadeva S, Carbone MF. et al. Functional dyspepsia. The Lancet 2020; 396: 1689-1702
  • 8 Aziz I, Palsson OS, Törnblom H. et al. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol 2018; 3: 252-262
  • 9 Madisch A, Andresen V, Enck P. et al. The Diagnosis and Treatment of Functional Dyspepsia. Dtsch Arztebl Int 2018; 115: 222-232
  • 10 Madisch A, Miehlke S, Labenz J. Management of functional dyspepsia: Unsolved problems and new perspectives. World J Gastroenterol 2005; 11: 6577-6581
  • 11 Madisch A, Vinson BR, Abdel-Aziz H. et al. Modulation of gastrointestinal motility beyond metoclopramide and domperidone: Pharmacological and clinical evidence for phytotherapy in functional gastrointestinal disorders. Wien Med Wochenschr 2017; 167: 160-168
  • 12 Talley NJ, Walker MM, Holtmann G. Functional dyspepsia. Curr Opin Gastroenterol 2016; 32: 467-473
  • 13 May B, Kuntz H-D, Kieser M. et al. Efficacy of a fixed peppermint oil/caraway oil combination in non-ulcer dyspepsia. Arzneimittelforschung 1996; 46: 1149-1153
  • 14 Madisch A, Heydenreich C-J, Wieland V. et al. Treatment of functional dyspepsia with a fixed peppermint oil and caraway oil combination preparation as compared to cisapride. A multicenter, reference-controlled double-blind equivalence study. Arzneimittelforschung 1999; 49: 925-932
  • 15 May B, Köhler S, Schneider B. Efficacy and tolerability of a fixed combination of peppermint oil and caraway oil in patients suffering from functional dyspepsia. Aliment Pharmacol Ther 2000; 14: 1671-1677
  • 16 Freise J, Köhler S. Pfefferminzöl/Kümmelöl-Fixkombination bei nicht-säurebedingter Dyspepsie-Vergleich der Wirksamkeit und Verträglichkeit zweier galenischer Zubereitungen. Pharmazie 1999; 54: 210-215
  • 17 Rich G, Shah A, Koloski N. et al. A randomized placebo-controlled trial on the effects of Menthacarin, a proprietary peppermint- and caraway-oil-preparation, on symptoms and quality of life in patients with functional dyspepsia. Neurogastroenterol Motil 2017; 29 (11)
  • 18 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
  • 19 Leicester RJ, Hunt RH. Peppermint oil to reduce colonic spasm during endoscopy. Lancet 1982; 2: 989
  • 20 Micklefield G, Jung O, Greving I. et al. Effects of intraduodenal application of peppermint oil (WS 1340) and caraway oil (WS 1520) on gastroduodenal motility in healthy volunteers. Phytother Res 2003; 17: 135-140
  • 21 Micklefield GH, Greving I, May B. Effects of peppermint oil and caraway oil on gastroduodenal motility. Phytother Res 2000; 14: 20-23
  • 22 Amato A, Liotta R, Mulè F. Effects of menthol on circular smooth muscle of human colon: analysis of the mechanism of action. Eur J Pharmacol 2014; 740: 295-301
  • 23 Krueger D, Schäuffele S, Zeller F. et al. Peppermint and caraway oils have muscle inhibitory and pro-secretory activity in the human intestine in vitro. Neurogastroenterol Motil 2020; 32: e13748
  • 24 Zong L, Qu Y, Luo DX. et al. Preliminary experimental research on the mechanism of liver bile secretion stimulated by peppermint oil. J Dig Dis 2011; 12: 295-301
  • 25 Gaudioso C, Hao J, Martin-Eauclaire MF. et al. Menthol pain relief through cumulative inactivation of voltage-gated sodium channels. Pain 2012; 153: 473-484
  • 26 Heimes K, Hauk F, Verspohl EJ. Mode of action of peppermint oil and (-)-menthol with respect to 5-HT3 receptor subtypes: binding studies, cation uptake by receptor channels and contraction of isolated rat ileum. Phytother Res 2011; 25: 702-708
  • 27 Harrington AM, Hughes PA, Martin CM. et al. A novel role for TRPM8 in visceral afferent function. Pain 2011; 152: 1459-1468
  • 28 May B, Funk P, Schneider B. Peppermint oil and caraway oil in functional dyspepsia – efficacy unaffected by H. pylori. Aliment Pharmacol Ther 2003; 17: 975-976
  • 29 Holtmann G, Stracke B. Effects of Menthacarin on symptoms and quality of life in patients with functional dyspepsia: Result of a 8-week optional placebo controlled follow-up. Zeitschrift für Gastroenterologie 2016; 54: KV420
  • 30 King MA, Pryce RL. Evidence for compliance with long-term medication: a systematic review of randomised controlled trials. Int J Clin Pharm 2014; 36: 128-135
  • 31 Jin J, Sklar GE, Min Sen Oh V. et al. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag 2008; 4: 269-286
  • 32 Madisch A, Miehlke S, Labenz J. et al. Sicherheit und Verträglichkeit einer Pfefferminzöl/Kümmelöl-Kombination bei funktionellen gastrointestinalen Beschwerden – ein systematischer Review. Internist (Berl) 2015; 56: 28 (Z025)
  • 33 Madisch A, Miehlke S, Labenz J. et al. Effectiveness of Menthacarin on symptoms of irritable bowel syndrome. Wien Med Wochenschr 2019; 169: 149-155