Peppermint oil makes swallowing easier
Peppermint oil (PO) may be effective for relieving dysphagia and chest pain caused by oesophageal motility disorders, according to a new study.
“Patients with distal oesophageal spasm (DES) and oesophagogastric junction outflow obstruction (EGJOO) … as well as those with delayed emptying on barium study, appeared to experience the most favourable response to this medication. No patients experienced new onset or worsening gastroesophageal reflux or other adverse events related to PO,” said researchers.
In the 38 patients (mean age, 65±13 years; 79 percent female) who were given PO for nonobstructive dysphagia (NOD) or noncardiac chest pain (NCCP), the overall rate of a favourable response was 63 percent (n=24). The median time from initial visit to follow-up was 6 months. [Dig Dis Sci 2019;doi:10.1007/s10620-019-05523-8]
While majority (37 percent; n=14) of the participants reported no noticeable changes in symptoms, 31.5 percent (n=12) said “they were much better.” Similarly, 31.5 percent (n=12) showed slight improvements in symptoms. There were no reports of worsening symptoms. Responders and nonresponders were comparable in terms of age (p=0.4) and sex distribution (p=0.9).
The median symptom relief score (SRS) was 4, indicating a slight improvement in burden.
Stratification according to the presenting symptom showed that PO was most effective in participants with simultaneous NCCP and NOD (response rate, 73 percent). The corresponding response rates for those with either NCCP or NOD alone were 63 percent and 53 percent.
This result is unexpected, given that chest pain associated with oesophageal dysmotility is typically more difficult to address than dysphagia, said researchers. “The beneficial effect of PO on chest pain may be explained by its smooth muscle relaxing properties in addition to its topical analgesic effect.”
On the other hand, disaggregation by manometric diagnosis revealed that patients with DES (83 percent; n=10 of 12) and EGJOO (100 percent; n=8 of 8) benefited the most from PO, as compared to those without such conditions (p<0.01). A similar trend was observed for SRS in DES and EGJOO patients (median, 4 and 5, respectively; p=0.02 and p=0.002, respectively).
“The lowest response rate (14 percent) was observed in symptomatic patients whose manometry was normal, indicating that relief was almost exclusively experienced by patients with spastic motility disorders and suggesting a physiologic basis for the effect of PO,” said researchers.
“Moreover, our results indicate that the response to PO was not influenced by other drugs that affect oesophageal physiology like [calcium channel blockers], nitrates, tricyclic antidepressants and opiates,” they added.
There were no reports of PO cessation due to side effects, nor of new onset or worsening pyrosis. No cases of heart burns, allergic reactions and burning sensation in the mouth were reported.
“[O]ur results should be considered hypothesis-generating and may serve as preliminary data to inform the design of an adequately powered double-blinded placebo-controlled randomized trial of PO, in which subjects are stratified according to objective manometric diagnoses, including DES and EGJOO,” said researchers.