Elsevier

Phytomedicine

Volume 13, Supplement 1, 24 November 2006, Pages 67-74
Phytomedicine

Spasmolytic and tonic effect of Iberogast® (STW 5) in intestinal smooth muscle

https://doi.org/10.1016/j.phymed.2006.08.004Get rights and content

Abstract

STW 5 (Iberogast®) is a fixed combination of nine medicinal plant extracts effective in the treatment of functional dyspepsia and irritable bowel syndrome. The effects of STW 5, a combination of Iberis amara fresh plant extract, and other eight plant extracts as well as single extract components including extracts from Menthae piperitae folium, Matricariae flos and Liquiritiae radix, were assayed in guinea pig ileum with or without stimulation with acetylcholine or histamine, in order to find a possible effect on the contractility of intestinal smooth muscle.

STW 5 decreased acetylcholine- and histamine-induced contraction of guinea pig ileum. This was also true for extracts of Menthae piperitae folium, Matricariae flos and L. radix. Extract from I. amara, however, showed no spasmolytic action; in contrary, it increased the basal resting tone and contraction of atonic ileal segments. This was also true when STW 5 was employed.

A spasmolytic action of STW 5 could also be observed in duodenum, jejunum and colon.

These data are the first to show not only the spasmolytic effects of STW 5 and its component extracts in intestinal muscle but also the tonicising effects of STW 5 through its component Iberis amara extract in relaxed intestinal muscle. Thus, pharmacological evidence suggests a dual-action principle and may explain, at least in part, the clinically observed therapeutic efficacy of STW 5 (Iberogast®) in both hypotonic and spastic dysmotility symptoms of functional dyspepsia and irritable bowel syndrome.

Introduction

STW 5 (Iberogast®) is a fixed combination of herbal extracts used in the therapy of motility-related diseases of the gastrointestinal tract (Allescher, 2006; Rösch et al., 2006). Its components are an aqueous-ethanolic fresh plant extract from Iberis amara totalis and drug extracts from peppermint leaves (Menthae piperitae folium), chamomile flower (Matricariae flos), liquorice root (Liquiritiae radix), angelica root (Angelicae radix), caraway fruit (Carvi fructus), milk thistle fruit (Silybi mariani fructus), lemon balm leaves (Melissae folium), and greater celandine herb (Chelidonii herba).

Earlier data show spasmolytic properties for Angelica roots on the smooth muscles of the intestinal tract (Izzo et al., 1996; Reiter and Brandt, 1985).The same has been found for chamomile flowers extract and its constituents (Achterrath-Tuckermann et al., 1980). Caraway fruits exhibited a concentration-dependent spasmolytic effect both with acetylcholine and with histamine-induced spasm of the guinea pig ileum, as well (Forster et al., 1980). Also for milk thistle fruits, a spasmolytic effect in isolated guinea pig ileum has been demonstrated (Liersch et al., 2003). Lemon balm leaves exerted spasmolytic effects on the ileum of the guinea pig and the duodenum of the rat (Reiter and Brandt, 1985; Forster et al., 1980). A spasmolytic action of peppermint leaves extract is also known (Forster et al., 1980; Forster, 1983). Moreover, for celandine herbs a spasmolytic effect in small intestine has been shown (Sato, 1935; Wrociński, 1960; Weiß, 1991), as well as for liquorice roots (Wrociński, 1960; Chandler, 1985).

In order to confirm part of these data for the extract combination STW 5, studies were conducted with isolated ileum of the guinea pig as well as with isolated duodenum, jejunum, ileum and colon of the rat. Moreover, some components of STW 5 including extracts of I. amara, Menthae piperitae folium, Matricariae flos and L. radix were tested using the isolated guinea pig ileum. They not only confirmed the spasmolytic effects in contracted intestinal muscle, but in addition STW 5 and I. amara showed tonicising effects in relaxed or only slightly contracted intestinal muscle.

Section snippets

Materials and methods

STW 5 (Iberogast®) contains I. amara totalis as a fresh plant extract and eight dried plants as drug extract (Table 1). STW 7 corresponds to STW 5, but without the extract of I. amara.

Negative control was a 31.5% v/v ethanol solution as contained in STW 5 and in the single plant extracts; positive control was papaverine.

The spasmodic agent for the induction of intestinal contraction was acetylcholine at 8–12 concentrations between 0.625 μg and 163 mg/l. In one experiment, histamine at 10

Antispasmodic actions

Using the isolated guinea pig ileum as a model, the effects of STW 5 (Iberogast®), STW 7 (STW 5 without extract of I. amara) and extracts from I. amara, Menthae piperitae folium, Matricariae flos and L. radix on acetylcholine-induced contractions were studied. The extract solvent ethanol served as control and papaverine for comparison. As shown in Fig. 1 and Table 2, STW 5 and STW 7 produced a significant and concentration-dependent inhibition of acetylcholine-induced contraction in the range

Discussion and conclusion

A spasmolytic effect in intestinal smooth muscle in vitro has been observed in several herbal drugs used in the therapy of motility-related functional gastro-intestinal diseases, the indication in which STW 5 is used. As STW 5 is a combination of several herbal extracts, it seems reasonable to discuss the effects of its components initially, and later those of the combination.

As shown in Fig. 1, Table 2, STW 5 and STW 7 decreased the spasmodic effect of acetylcholine in a concentration-related

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    The data in current publication are derived from experiments conducted between 1985 and 1993. Part of them was preliminary published in 1993 (Okpanyi et al., 1993).

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