RESidENcy PROGRAM Scholarly and Community Medicine Projects

CME
Evidence-Based Practice
Answering clinical questions with the best sources VOLUME 13 NUMBER 2 FEBRUARY 2010
INTEGRATIVE MEDICINE IN DEPTH
3 Is saw palmetto helpful for benign
prostatic hyperplasia?
HELPDESK ANSWERS
4 What methods are effective for reducing
the incidence of dental caries?
5 What common food additives can cause acute,
nonallergic symptoms?
6 Are group visits effective for the treatment
of obesity?
7 What are appropriate treatment goals
for hypertension in the very elderly
(≥80 years)?
8 What are the risks of overtreating
hyperlipidemia with statins?
9 Do you need to use heparin when initiating
warfarin therapy in a patient with atrial
fibrillation?
10 Should you treat an upper extremity deep
venous thrombosis with anticoagulation?
10 Should you use anticoagulation in an elderly
patient with atrial fibrillation?
11 Are inhaled corticosteroids effective for patients
with chronic obstructive pulmonary disease?
BEHAVIORAL HEALTH MATTERS
13 Which symptoms best distinguish unipolar
and bipolar depression?
SPOTLIGHT ON PHARMACY
14 Do inhaled beta-agonists control cough
in acute bronchitis?
CME TEST
15 February 2010
Peppermint oil as a therapeutic agent
for irritable bowel syndrome
Bottom line
Peppermint oil is a safe and effective therapeutic agent for pain and
abdominal discomfort in patients with irritable bowel syndrome (IBS).
It should be considered as an adjunct in IBS management, however, as
pain is only one component of the clinical picture.
Background
IBS is a chronic, relapsing gastrointestinal disorder without a known
structural or anatomical explanation. Mechanisms of altered gastrointestinal
motility, smooth muscle spasm, visceral hypersensitivity,
and abnormalities of central pain processing have all been implicated.
Many modalities have been used to control IBS symptoms, including
bulk-forming agents, prokinetics, antispasmodics, antidepressants,
exercise, yoga, stress relief, and diet changes, but evidence supporting
many of these methods is limited by relatively poor methodology
and inconclusive findings. Generally, a holistic approach is required to
improve the overall management of this condition, because no individual
intervention has a high success rate.
The use of peppermint oil is a nontraditional therapy that has been
studied as an inexpensive and easily attainable adjunct for IBS symptoms.
Bench research shows its major constituent, menthol, blocks Ca 2+ channels
in the gut and decreases smooth muscle spasm. Peppermint oil also has a
relaxing effect on the gall bladder and slows orocecal transit time. 1
Summary of Evidence
Meta-analysis
A review of fiber, antispasmodics, and peppermint oil showed that all 3 of
these agents are more effective than placebo in the treatment of IBS. Four
studies compared peppermint oil with placebo in 392 adults. Only 26%
of the patients randomized to peppermint oil had persistent symptoms
compared with 65% receiving placebo (relative risk [RR]=0.43; 95% confidence
interval [CI], 0.32–0.59; number needed to treat [NNT]=2.5). 2
When the 3 studies with the highest methodological quality were
considered, the relative risk of persistent symptoms was of a similar magnitude
(RR=0.40; 95% CI, 0.29–0.55). Adverse events were reported in
Evidence-Based Practice / Vol. 13, No. 2 1