Treatment of irritable bowel syndrome with multi-herbal formula:A case report

Atif Ali Khan Khalil

Abstract—Background:Many patients with irritable bowel syndrome (IBS) try the approach of complementary or herbal medicines,as western medications do not treat IBS.The current case report presents the combine effect of four herbal components as a traditional treatment of IBS.Method:The herbal components were purchased from the local market.The components including Lipidium sativum L., Trigonella foenum-graceum L.,Myristica fragrance Hoyutt.and Apium graveolens Linn were ground and mixed well(dry weight),and took orally for two days as advised by the local healer.Results:The symptoms included loose bowel movements accompanied by prolonged flatulence abdominal cramping,faecal urgency as well as mucus discharge were improved and remain suppressed for 5 to 6 months after the treatment with multi-herbal formula.Conclusion:The current case report showed that the multi-herbal formula might be a promising treatment for IBS-diarrhoea.

Keywords—Irritable bowel syndrome (IBS),Diarrhoea,Multi-herbal formula,Case report

I.BACKGROUND

Irritable bowel syndrome (IBS) is the most common disorder of the gastrointestinal tract [1].It is a functional disorder often accompanied with the symptoms including changed in bowel habits,abdominal pain,and alterations in stool frequency [2].Several studies proved that the quality of life related with health is markedly altered in the patients of IBS [3].Approximately 10% to 15% of the population is effected worldwide and carries a considerable disease burden in terms of increased healthcare costs and decreased productivity as well as reduced health-related quality of life [4,5].The causes and pathophysiology of irritable bowel syndrome are still not clear.The proposed pathophysiology may include irrational and excessive use of antibiotics and infection,contributing to alteration in microbial flora of the intestine[6].Currently,there is no approved treatment protocol for IBS.Herbal remedies are an alternative treatment,such asMentha piperita(peppermint oil) [7].The leaf extract ofCynara cardunculus(artichoke) has also been displayed to decrease symptom in patients with severe dyspepsia identified as suffering from IBS [8-10].

The local healers have long used the multi-herb formula for the treatment of IBS with diarrhoea.The multi-herbal formula consists of the following four components:(i)Lipidium sativumL.,(ii)Trigonella foenum-graceumL.,(iii)Myristica fragranceHoyutt.and (iv)Apium graveolensLinn.Interestingly,each component of the multi-herbal formula has been reported to have traditional use relevant to IBS such as diarrhoea,dysentery and gasteroprotective effects.Lipidium sativumL.(cruciferae) in traditional system has been used for the treatment of liver problems,jaundice,spleen diseases,gastrointestinal disorders,menstrual problems,arthritis,and inflammatory conditions [11-13].Trigonella foenum-graceumL.(Legouminosae) seeds and aerial parts has long been used as a valuable source of protein for humans and ani-mal nutrition,as well as for various conditions in conventional medicine [14].Myristica fragranceHoyutt.(Myristicaceae)used as components of teas,soft drinks or mixed in alcohol and milk,and extensively used in curry powder in Asia.For centuries,M.fragranshas been used as a folklore medicine for treating mouth sores,diarrhoea and insomnia [15].Apium graveolensLinn (Apiaceae) has been used in the conventional system of medicine to treat spasm and stomach problems and as a diuretic,and sedative [16].

On the basis of these traditional uses of components,the multi-herb formula could have good potential as a novel treatment for IBS.Therefore,the present case study will report the treatment of IBS by herbal formula.

Case presentation Patient characteristic and medical history

A 28-years old boy who was diagnosed with irritable bowel syndrome(about 22 years ago)by examination of sign,symptoms and other investigations.Symptoms included loose bowel movements (approx.8 times per day) accompanied by faecal urgency as well as mucus discharge.He also experienced prolonged flatulence,bloating and abdominal cramping.The symptoms of the patients were severe.He had no smoking history.He had been followed up by gastroenterologists for more than 16 years and had undergone sigmoidoscopy,upper endoscopy,multiple colonoscopies and enteroclysis,barium enemas;all these tests displayed normal results.History reveals that he has no cardiopulmonary abnormalities,no hepatosplenomegaly,masses,or tenderness.CT (computed tomography) scans of the pelvis and abdomen with intravenous (IV) and oral contrast had been performed within these 16 years and were normal.The last duodenum biopsy had been performed in 2009 and showed very focal broadening and shortening of villi and increased intraepithelial lymphocytosis were noted.In biopsy no giardia was found.The patient had been previously treated for IBS with various medications including spasmolytic (trimebutine and mebeverine),loperamide,metronidazole,digestive enzymes,dietary fibre (isphaghula husk),antihelminthic,anxiolytic and hypnotic drugs (benzodiazepines),tricyclic antidepressants,multivitamins,and an empiric course of antibiotics.During treatment,he had improved his symptoms in the initial days but failed to sustained results.

Treatment and outcome of symptoms

The patient was distinctly biased against and was never amenable to any homeopathic,naturopathic,or ethnobotanical remedies and had never tried any of these treatment options.About three years ago,a local healer advises and made a multi-herbal formula consist of four herbal components (Table 1 and Figure 1).After the patient took the multi-herbal formula two times a day.Symptoms such as loose bowel movements,faecal urgency,mucus discharge,prolonged flatulence,bloating and abdominal cramping began to improve approximately one day later and remained suppressed for about 4 to 6 months.In addition,the patient took multi-herbal formula again for two days when symptoms appeared.Since then the patient continued the herbal remedy and has surprisingly improved IBS,improved quality of life,and a significantly improved level of exercise tolerance.

Table 1.A list of multi-herbal formula components

Preparation of Multi-Herbal Formula

The patient purchased the herbal items from the local market.Firstly,the patient slightly give heat to the nutmeg(Myristica fragrance),after sometime,the shell was removed and was grind completely.Other three herbal items namely fenugreek (Trigonella foenum-graceum),garden cress (Lipid-ium sativum) and celery seeds (Apium graveolens) were also grind properly to make it fine powder(Figure 1).Then all items were mixed completely in a same ratio (one gram each).The patient take one to two table spoon of this herbal formula before meal with black tea or sometimes with slight sugar to avoid the bitter taste.In addition,during treatment the patient avoid the follwingfoods,milk,yogurt,cold drinks and rice.Moreover,the patient keeps continued the avoid foods after the treatment.

Figure 1.Components of multi-herbal formula

II.DISCUSSION

The aim of this case study was to report the multi-herbal preparation containing a combination of garden cress,fenugreek,nutmeg and celery in the treatment of gastrointestinal disorders especially IBS associated with chronic diarrhoea.Owing to a diverse spectrum of naturally derived chemical constituents,plants commonly exhibit diverse pharmacological effects.The garden cress (L.sativumseeds)has been used for the treatment of abdominal discomfort,such as dysentery and diarrhoea[11,12].Rehman et.al reported that the seed extract ofL.sativumat 100 and 300 mg/kg inhibited significantly castor oil-induced diarrhoea in rats.The antidiarrheal and spasmolytic effect might be due to dual blockade of muscarinic receptors and Ca++channels [13].The presence of different classes of chemical constituents,such as alkaloids,saponins and anthraquinones have been displayed by the extract of garden cress.Further,alkaloids and β-sitosterol have been previously reported as antispasmodic [17].Thus,the presence of these phytochemicals in the seeds ofL.sativummight be responsible for relieving diarrhoea and spasm of the patient.Another component of herbal preparation,fenugreek (T.foenum-graceum) was previously reported to have various medicinal properties such as gastric stimulant,carminative,antidiabetic and galactogogue (lactation-inducer) [14].One of the studies displayed that oil extracted from fenugreek seed showed gastroprotective activity.In a group of mice indomethacin induce ulcer was significantly decreased.The decrease in the gastric ulcer might be due to the presence of saponins,trigonelline and phytic acid in the essential oil of fenugreek seeds [18].One another in-vivo study showed the protective effect of fenugreek seed (aqueous extract) against reflux esophagitis (RE) [19].Hence,fenugreek can be attributed as a gastroprotective effect in symptomatic treatment of the IBS patient.Additionally,the other component celery (A.graveolens) might contributes its spasmolytic and analgesic activity to herbal preparation.This hypothesis was supported by previously reported work.Atta et al,reported that the ethanolic extract of the seed of celery possessed significant analgesic activity when tested against acetic acid induced writhing and hot plate method [20].In addition,other studies also showed that the analgesic effect of celery is attributed to the involvement of celery in the cytochrome P450,which was found to be decreased in the liver homogenate [21].Further the anti-spasmolytic activity are also showed by ethanolic extract of celery.The activity may be attributed due to the presence of a flavonoid,apigenin [22].Nutmeg has long history of traditional usage such as carminative,stomachic,stimulant as well as for intestinal catarrh and colic,to control flatulence,to stimulate appetite,and also renown as an abortifacient and emmenagogue [15].Further,the petroleum ether extract revealed similar activities to NSAID (non-steroidal antiinflammatory drugs)[23].Furthermore,previous reported study also revealed that the methanol extract of nutmeg has promising anti-inflammatory activity.The anti-inflammatory action of nutmeg may be due to the myristicin a phenylpropene,natural small molecules present in nutmeg[24].Hence,the anti-inflammatory and antiflatulence action may be due to the presence of nutmeg in the herbal formula.

III.CONCLUSIONS

Current case study suggests that multi-herbal formula has a positive and significant effect on IBS symptoms,relieving pain and improving the quality of life.The effect may be due to anti-oxidant,anti-inflammatory,antiflatulence and spasmolytic activities of herbal formula,it is a potentially useful addition to the spectra of agents for managing IBS.Multi-herbal formula also seems to be safe and well-tolerated,with no serious adverse events reported by the patient.However,current study is too limited to be considered as a fact and evidence.More extensive clinical trials and examinations involving a standardized herbal preparation and variable and unique sample sizes should be adopted in future.

Acknowledgment:

The Author is thankful to Prof.Dr.Zahid ullah,(Department of botany,University of Swat,KPK,Pakistan) for helping in identification of components used in Multi-herbal formula.The author also thankful to the local healer and patient for helping and in completion of this case study.Furthermore,the author also thankful to Dr.Ammad Fahim (National University of Medical Sciences)for constructive suggestions.

Ethics statement:

Written informed consent was obtained from the patient for the publication of any potentially identifiable images or data included in this article.

Conflict of interest:

The authors declare no conflicts of interest

Citation:

Khalil AAK.Treatment of irritable bowel syndrome with multi-herbal formula:A case report.Drug Comb Ther.2021;3(3):15.doi:10.53388/DCT2021080505

Executive editor:Na Liu.

Submitted:01 June 2021,Accepted:02 August 2021,Online:03 August 2021.

?2021 By Authors.Published by TMR Publishing Group Limited.This is an open access article under the CC-BY license(http://creativecommons.org/licenses/BY/4.0/).