Clinical effects of STW 5 (Iberogast^®) are not based on acceleration of gastric emptying in patients with functional dyspepsia and gastroparesis

Abstract

STW 5, a herbal extract, is effective for the treatment of symptoms in patients with functional dyspepsia (FD). However, its mode of action is still unclear and a modulation of gastric motility is hypothesized. This multicentre, placebo-controlled double-blind study addressed the question of whether STW 5 accelerates gastric emptying in patients with FD and gastroparesis. One-hundred and three patients diagnosed with FD were randomly assigned to a treatment with either STW 5 or a liquid placebo for 28 days. The primary end point of the study was a change of a validated gastrointestinal symptom (GIS) score under treatment. Additionally, patients underwent a (13)C octanoic acid breath test for the assessment of the gastric half-emptying time (t(1/2)). Patients with prolonged t(1/2) were diagnosed with gastroparesis and requested to repeat the test at the end of treatment. A change of t(1/2) was defined a secondary study end point. t(1/2) was prolonged in 48.6% of patients in the STW 5 group and in 43.8% of the placebo group. During treatment, t(1/2) increased non-significantly in patients treated with STW 5 (+23 +/- 109 min; P = 0.51) and slightly accelerated among patients in the placebo arm (-26 +/- 51 min; P = 0.77) (P = 0.49). The improvement of the GIS (P = 0.08) and the proportion of patients with a treatment response (P = 0.03) were more pronounced in the STW 5 group. Our findings suggest that the clinical effects of STW 5 in patients with FD and gastroparesis are not directly mediated by an acceleration of gastric emptying. A clear-cut correlation with symptom improvement is still lacking.

STW 5 (Iberogast) Therapy in Gastrointestinal Functional Disorders

“…Treatment with STW 5 resulted in an improvement of the GIS ( p = 0.08) and in a higher proportion of patients with symptom response compared to placebo ( p = 0.03). STW 5 had, however, no effect on gastric emptying when compared with placebo [8]. The beneficial effects of STW 5 observed in this study were, therefore, most likely related to changes of visceral perception or hypersensitivity.…”

“…However, this effect is not based on the regulation of gastric emptying. Braden et al [8] included 103 patients with FD in a randomized clinical trial. The patients were treated for 28 days either with STW 5 or with placebo.…”

Possibilities of Multi-Tarfgeted Therapy of Functional Gastrointestinal Tract Disturbances

“…Переносимость препарата оценива-лась врачами и пациентами как «очень хорошая» или «хорошая» у 88 и 96% больных соответственно [14][15][16].…”

Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia

“…It was effective for irritable bowel syndrome in children, but has not been specifically studied in FD [191] . Iberogast (STW 5), an herbal preparation, improves symptoms in FD, but there is not clear data determining whether effects are directly mediated by acceleration of gastric emptying or an alternate mechanism [192,197] .…”

“…Complementary therapies such as ginger [189,190] , peppermint oil [191] , and iberogast [192] , may also have a role in the treatment of FD. Ginger enhances gastric emptying in healthy volunteers and adults with FD but had no impact on FD symptoms [193,194] .…”