Article: Peppermint Oil Suppresses GI Spasms During Upper Endoscopy

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Peppermint Oil Suppresses GI Spasms During Upper Endoscopy

May 2, 2003 - Peppermint oil administered intraluminally has superior

efficacy and fewer adverse effects than hyoscine-N-butylbromide (hyoscyamine

sulfate) for suppression of gastrointestinal (GI) spasms during upper

endoscopy, according to the results of a randomized, double-blind,

double-dummy trial published in the April issue of Gastrointestinal

Endoscopy.

" GI endoscopy without general anesthesia causes a hyperperistaltic state in

the stomach, which frequently necessitates the use of antispasmodic agents,

such as hyoscine-N-butylbromide, but these drugs have side effects, " write

Naoki Hiki, MD, PhD, from the University of Tokyo Graduate School of

Medicine in Japan, and colleagues. " Peppermint oil is harmless and acts

locally to inhibit GI smooth muscle contraction. "

In 100 patients, the investigators compared the antispasmodic effects of

intramuscular hyoscyamine and a placebo solution given intraluminally via

endoscopy, and also the effects of a placebo solution given intramuscularly

with those of a peppermint oil solution given intraluminally.

The opening ratio, defined as the percent change in diameter of the pyloric

ring before and after the administrations, was significantly higher in the

peppermint oil group than in the hyoscyamine group. The contraction ratio,

defined as the percent change in diameter between the maximally and

minimally opened pyloric ring states, was significantly lower after

peppermint oil administration than after hyoscyamine injection.

The time required for disappearance of the antral contraction ring(s) was

97.1 ± 11.4 seconds in the peppermint oil group, compared with 185.9 ± 10.1

seconds in the hyoscyamine group (P < .0001). Although hyoscyamine injection

produced adverse effects such as dry mouth, blurred vision, and urinary

retention, there were no significant adverse effects with peppermint oil.

A major study limitation is intramuscular instead of intravenous

administration of hyoscyamine, because the longer period required for

intramuscular absorption may have affected the time needed for the drug to

inhibit peristalsis.

" Peppermint oil solution administered intraluminally can be used as an

antispasmodic agent with superior efficacy and fewer side effects than

hyoscine-N-butylbromide administered by intramuscular injection during upper

endoscopy, " the authors write. " In a preliminary study of the effects of

Hyoscyamine administered intravenously and peppermint oil solution given

intraluminally, a more rapid and potent antispasmodic effect of the latter

also was observed. The investigators propose to study the antispasmodic

effect of peppermint oil on other smooth muscle structures, such as the

major duodenal papilla and the duodenum itself, and the potential use of

this agent during ERCP and colonoscopy. "

Gastrointest Endosc. 2003;57:475-482