Herbal medicines in functional dyspepsia-Untapped opportunities not without risks

Kok-Ann Gwee, Gerald Holtmann, Jan Tack, Hidekazu Suzuki, Jinsong Liu, Yinglian Xiao, Min-Hu Chen, Xiaohua Hou, Deng-Chyang Wu, Clarissa Toh, Fang Lu, Xu-Dong Tang, Kok-Ann Gwee, Gerald Holtmann, Jan Tack, Hidekazu Suzuki, Jinsong Liu, Yinglian Xiao, Min-Hu Chen, Xiaohua Hou, Deng-Chyang Wu, Clarissa Toh, Fang Lu, Xu-Dong Tang

Abstract

Background: Contemporary treatments for functional dyspepsia have limitations. Herbal medicine has been suggested as adjunctive treatment. With growing scientific recognition and public interests, an in-depth review of this is timely.

Aims/purpose: To evaluate the therapeutic potential and problems that may be associated with the adoption of herbal medicines in functional dyspepsia.

Methods: We reviewed the treatment landscape of functional dyspepsia and assessed the scientific community's interest in herbal medicine. Preclinical pharmacological and clinical trial data were reviewed for several herbal medicines available in the market. Challenges associated with adoption of herbal medicine in mainstream medicine were critically evaluated.

Results: We found that herbal medicines frequently comprise a combination of herbs with multiple reported pharmacological effects on gastrointestinal motility and secretory functions, as well as cytoprotective and psychotropic properties. We identified a number of commercially available herbal products that have undergone rigorous clinical trials, involving large numbers of well-defined subjects, reporting both efficacy and safety for functional dyspepsia. Persisting concerns include lack of rigorous assessments for majority of products, toxicity, consistency of ingredients, dose standardizations, and quality control. We provide a quality framework for its evaluation.

Conclusions: We commend herbal medicine as a viable future option in managing functional dyspepsia. An attractive appeal of herbal medicine is the prospect to simultaneously target multiple pathophysiological mechanisms. Wider adoption and acceptance of herbal medicines in treatment algorithms of functional dyspepsia will require the application of the scientific rigor expected of chemical therapies, to all stages of their development and evaluation.

Keywords: functional dyspepsia; gastrointestinal physiology; herbal medicine; pharmacology; toxicity; treatment algorithms.

Conflict of interest statement

Kok‐Ann Gwee has given scientific advice to Adare and Biocodex, and has been on the speaker bureau of Biocodex, Eisai, and Takeda. Gerald Holtmann has given scientific advice to Allergan, Danone, Bayer, Takeda, and Zeria, and has been on the speaker bureau of Bayer and Gaetz. His organization has received research support from Abbott, Bayer, Boehringer Ingelheim, and Novartis. Jan Tack has given Scientific advice to Adare, AlfaWassermann, Allergan, Christian Hansen, Danone, Grünenthal, Ironwood, Janssen, Kyowa Kirin, Menarini, Mylan, Neutec, Novartis, Noventure, Nutricia, Shionogi, Shire, Takeda, Theravance, Tramedico, Truvion, Tsumura, Zealand, and Zeria pharmaceuticals; has received research support from Shire, Sofar, and Tsumura; and has served on the Speaker bureau for Abbott, Allergan, AstraZeneca, Janssen, Kyowa Kirin, Menarini, Mylan, Novartis, Shire, Takeda, Truvion, and Zeria. Hidekazu Suzuki, has received research support from Daiichi‐Sankyo, EA pharma, Mylan, MSD, Takeda, and Tanabe and has received lecture fee from AstraZeneca, Astellas, Daiichi‐Sankyo, EA pharma, Mylan, Otsuka, and Takeda. Jinsong Liu, Yinglian Xiao, Min‐hu Chen, Xiaohua Hou, Deng‐Chyang Wu, Clarissa Toh, Fang Lu, and Xu‐Dong Tang have no competing interests.

© 2020 John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
A, Publication charts showing increasing number of publications for functional dyspepsia. B, Publication charts showing increasing number of publications for irritable bowel syndrome. Source: PubMed. (As of March 8th 2020). Abbreviations: CAM, Complementary and Alternative Medicine; HM, Herbal Medicine; TCM, Traditional Chinese Medicine
FIGURE 2
FIGURE 2
Herbal compounds for FD: pharmacological effects on gastric functions. 28 , 35 , 36 , 37 , 38 , 39 Abbreviations: ALE, Artichoke leaf extract; RKT, Rikkunshito; STW‐5, Iberogast; ZZKZ, ZhiZhu KuanZhong

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