Irritable bowel syndrome (IBS) is characterized by abdominal pain and alterations in bowel movements. Patients with IBS have a higher rate of depression and anxiety and have a decreased quality of life (QOL). Boswellia (Boswellia carteri, Burseraceae) gum resin has anti-inflammatory properties and antidepressant effects. Ginger (Zingiber officinale, Zingiberaceae) rhizome has antibacterial, antifungal, and antioxidant effects. Yarrow (Achillea millefolium, Asteraceae) aerial part has anxiolytic effects and is used to treat gastritis. Boswellia and ginger have been used to treat IBS. The purpose of this randomized, placebo-controlled study was to evaluate the effects of a combination of Boswellia, ginger, and yarrow on IBS symptoms, QOL, anxiety, and depression in patients with IBS.
Patients (n = 60, aged > 18 years) with mild-to-moderate IBS according to ROME III criteria were recruited from the psychosomatic clinic at Isfahan University of Medical Sciences (IUMS), Isfahan, Iran from 2015 to 2016. Excluded patients were receiving treatment for IBS or were pregnant. Patients received either placebo (starch) or a mixture of Boswellia, ginger, and yarrow (source, preparation, concentration, and the dose of the herbal ingredients not reported), which was encapsulated by the IUMS pharmacy school. Patients took one capsule every eight hours for one month. At baseline, four weeks, and 12 weeks, IBS severity was assessed using the IBS-severity scoring system (IBS-SSS), and anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS).
Ten patients in the treatment group and eight patients in the control group were dropped from the study due to failure to comply with the study protocol. Compared with placebo and baseline, the treatment group had significant improvement in abdominal pain severity (P = 0.001 and P < 0.001, respectively), abdominal pain frequency (P = 0.01 and P < 0.001, respectively), bloating severity (P = 0.002 and P < 0.001, respectively), and depression (P < 0.001 for both). Compared with placebo, the treatment group had a significant improvement in satisfaction with bowel habits (P < 0.001) and anxiety (P = 0.03). QOL scores did not significantly differ between groups.
There were significantly more men in the placebo group (73%) than in the treatment group (55%) (P = 0.023). When the results were stratified by gender, there appeared to be a gender-dependent effect on some outcomes. Namely, there were significant differences between treatment and control groups in abdominal pain severity, abdominal pain frequency, and bloating severity (P < 0.001, P < 0.001, and P = 0.008, respectively) in women, but not men. QOL was significantly improved in men (P = 0.01) but not women (P = 0.18).
There were no adverse events (AEs) in the placebo group and four mild AEs in the treatment group which included two reports of diarrhea, one report of nausea, and one report of itching.
The authors conclude that the herbal combination significantly reduced the severity of IBS symptoms, especially in women. Limitations of this study include the small sample size (n=42), short duration (one month), use of only two subjective outcome measures, failure to report randomization and blinding, and most importantly, the lack of information on the herbal treatment. Due to the latter, the promising results of this pilot study cannot be replicated to confirm and expand on the findings. It is unclear how the study could have been published without this vital information.
The authors declare no conflicts of interest and no financial support.
Kazemian A, Toghiani A, Shafiei K et al. Evaluating the efficacy of mixture of Boswellia carterii, Zingiber officinale, and Achillea millefolium on severity of symptoms, anxiety, and depression in irritable bowel syndrome patients. J Res Med Sci. November 2017;22;120. doi: 10.4103/jrms.JRMS_905_16.