What is the role of Iberogast (clincally proven herbal extract) in treating functional dyspepsia and irritable bowel syndrome (IBS)?

Iberogast in Treating Functional Dyspepsia and Irritable Bowel Syndrome

Iberogast (STW 5) is an effective herbal preparation for treating functional dyspepsia and irritable bowel syndrome (IBS), showing significant improvement in gastrointestinal symptoms compared to placebo with excellent tolerability. 1

Composition and Mechanism of Action

• Iberogast is a complex herbal preparation consisting of nine plant extracts: fresh plant extract of Iberis amara plus extracts from Chelidonii herba, Cardui mariae fructus, Melissae folium, Carvi fructus, Liquiritiae radix, Angelicae radix, Matricariae flos, and Menthae piperitae folium 2
• It has a unique dual action mechanism:
  • The Iberis amara component provides a tonic effect on relaxed intestinal muscle 3
  • The other herbal extracts (particularly peppermint, chamomile, and licorice) provide spasmolytic effects 3
• This dual action allows Iberogast to regulate gastrointestinal motility in both hypotonic and spastic conditions 3

Efficacy in Functional Dyspepsia

• Meta-analyses of double-blind, randomized clinical trials have demonstrated a clear, highly significant therapeutic effect of Iberogast in treating functional dyspepsia 1
• Clinical trials have shown Iberogast to be comparable in effectiveness to prokinetic agents like metoclopramide and cisapride for dyspepsia symptoms 2
• The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines note that Iberogast has been shown to be at least as effective as metoclopramide in improving symptoms of functional dyspepsia 4
• The herbal preparation significantly improves gastrointestinal symptom scores compared to placebo 5

Efficacy in Irritable Bowel Syndrome

• Clinical studies have demonstrated efficacy in treating IBS symptoms, though the evidence base is smaller than for functional dyspepsia 2, 6
• The British Society of Gastroenterology guidelines for IBS management recognize that certain antispasmodics and peppermint oil (components found in Iberogast) may be effective treatments for global symptoms and abdominal pain in IBS 4
• Peppermint oil, a key component of Iberogast, was ranked first for global symptom improvement in IBS in systematic reviews 4

Advantages Over Conventional Treatments

• Iberogast targets only the gastrointestinal tract and enteric nervous system without affecting the central nervous system, resulting in fewer side effects than many conventional medications 2
• The multi-component nature of Iberogast may be advantageous for heterogeneous conditions like functional dyspepsia and IBS, where multiple pathophysiological mechanisms are involved 6
• The preparation has excellent tolerability with adverse events comparable to placebo 1

Clinical Application

• Iberogast can be considered as part of the treatment approach for patients with functional dyspepsia or IBS who have not responded adequately to first-line treatments 6
• It may be particularly useful for patients with mixed symptoms or alternating bowel patterns, given its dual regulatory effect 3
• The British Society of Gastroenterology guidelines note that antispasmodics (like components in Iberogast) may be an effective treatment for global symptoms and abdominal pain in IBS, though with a weak recommendation based on very low-quality evidence 4

Safety Profile

• Toxicological studies have found both the fresh plant extract of Iberis amara and the combined preparation of Iberogast to be safe in therapeutically effective doses 2
• Adverse events are rare and comparable to placebo in frequency and spectrum 2
• Unlike some conventional medications for functional gastrointestinal disorders, Iberogast does not have significant central nervous system effects 2

Limitations and Considerations

• While Iberogast has shown efficacy, it should be considered within the context of a comprehensive management approach for functional gastrointestinal disorders 4
• The British Society of Gastroenterology guidelines emphasize that treatment of IBS should be directed toward the predominant symptom(s) experienced by the patient 4
• For patients with severe symptoms not responding to conventional treatments including herbal preparations, referral to a multidisciplinary team may be necessary 4