Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome

Aliment Pharmacol Ther. 2022 Sep;56(6):932-941. doi: 10.1111/apt.17179.Epub 2022 Aug 9.


Maria Rosa Ingrosso 1 2Gianluca Ianiro 1 2Judy Nee 3Anthony J Lembo 3Paul Moayyedi 4Christopher J Black 5 6Alexander C Ford 5 6


Author information

1Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

2Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.

3Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

4Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.

5Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.

6Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.


Background: Irritable bowel syndrome (IBS) is one of the most common disorders of gut-brain interaction, with a complex pathophysiology. Antispasmodics are prescribed as first-line therapy because of their action on gut dysmotility. In this regard, peppermint oil also has antispasmodic properties.

Aim: To update our previous meta-analysis to assess efficacy and safety of peppermint oil, particularly as recent studies have cast doubt on its role in the treatment of IBS METHODS: We searched the medical literature up to 2nd April 2022 to identify randomised controlled trials (RCTs) of peppermint oil in IBS. Efficacy and safety were judged using dichotomous assessments of effect on global IBS symptoms or abdominal pain, and occurrence of any adverse event or of gastro-oesophageal reflux. Data were pooled using a random effects model, with efficacy and safety reported as pooled relative risks (RRs) with 95% confidence intervals (CIs).

Results: We identified 10 eligible RCTs (1030 patients). Peppermint oil was more efficacious than placebo for global IBS symptoms (RR of not improving = 0.65; 95% CI 0.43-0.98, number needed to treat [NNT] = 4; 95% CI 2.5-71), and abdominal pain (RR of abdominal pain not improving = 0.76; 95% CI 0.62-0.93, NNT = 7; 95% CI 4-24). Adverse event rates were significantly higher with peppermint oil (RR of any adverse event = 1.57; 95% CI 1.04-2.37).

Conclusions: Peppermint oil was superior to placebo for the treatment of IBS, but adverse events were more frequent, and quality of evidence was very low. Adequately powered RCTs of peppermint oil as first-line treatment for IBS are needed.


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