Peppermint can help with the difficulty of swallowing and non-cardiac chest pain experienced by some patients with disorders of the esophagus, investigators at the Medical University of South Carolina (MUSC) have reported.
Out of the 38 patients enrolled in the MUSC pilot study, 63 per cent reported improvement of symptoms.
Patients were recruited from the Esophageal Disorders Clinic at the MUSC Health Digestive Disease Center (HDDC).
The Medical Director, an esophageal disorders research fellow at MUSC/HDDC and first author on the article, Mohamed Khalaf, said peppermint oil was an established agent in the treatment of irritable bowel syndrome.
“We tried to examine its effect on patients with swallowing and chest pain issues with no apparent cause,” he said.
A professor emeritus in the MUSC College of Medicine, nationally recognised gastroenterologist and senior author on the article, Donald Castell, said their findings suggested that peppermint might help prevent symptoms by relaxing the smooth muscle in the lower esophagus, and added that peppermint oil had been known to have therapeutic effect in multiple disorders due to its muscle-relaxing properties.
However, only two previous studies have investigated the role of peppermint in the upper digestive tract.
The MUSC study found that patients who took peppermint oil tablets before eating felt better after meals than those who did not. Those with both non-cardiac chest pain and unobstructed difficulty swallowing saw the most benefits: 73 per cent of them reported feeling better. Of patients with just one of the symptoms, those with non-cardiac chest pain had a more positive response from the peppermint oil (63 per cent) than those with difficulty swallowing (53 per cent).
The results were even better among patients with spastic disorders of the esophagus: 83 per cent reported feeling better or slightly better. Although less well-known than esophageal disorders such as acid reflux, spastic disorders of the esophagus can also disrupt a patient’s life. In these disorders, the esophagus undergoes painful spasms that can interfere with eating because the spasms occur only from time to time. The disorders are difficult to diagnose and treat.
Current standard care for these disorders involves trying multiple drugs, including tricyclic antidepressants and calcium channel blockers, and hoping that one works.
Peppermint offers an attractive first line of defence for these patients who experience intermittent symptoms because they can take it freely as symptoms occur.
“In this study, patients who had experienced difficulty swallowing took two pieces of a commercially available peppermint before meals. Those with chest pain took the peppermint tablets as needed,” says Khalaf.
This study highlights the effects of the so-called Charleston Approach which advocates a “start low and go slow” treatment strategy. The approach differs from current standard of care in that it uses peppermint oil as a first attempt to relieve symptoms.
Castell and Khalaf caution that patients must first be examined by a doctor to rule out heart disease and undergo a procedure known as endoscopy to rule out obstruction before they are offered peppermint as a first-line treatment.
Although the preliminary findings of this study are promising, they need to be confirmed in a trial that compares outcomes in patients who receive a specific dose of peppermint oil and those who receive only a placebo.
In the meantime, however, patients who have been diagnosed as having spastic disorders of the esophagus and who have no heart disease or obstruction can try using peppermint to see if it relieves their symptoms.
“Given the safety profile, low cost, and widespread availability, there are no risks from empirical use of peppermint oil,” said Khalaf.
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