Multi target action of the herbal combination STW 5 in dyspeptic heartburn

• Published in: Planta Medica
• Main Authors: Abdel-Aziz, H, Kelber, O, Vinson, B, Weiser, D, Müller, MH, Khayyal, MT
• Format: Conference Proceeding
• Language: English
• Published: 21.07.2009
• DOI: 10.1055/s-0029-1234869
• ISSN: 0032-0943

A multi-target action is the key to understanding the effect of herbal medicines in a large number of therapeutic fields. To these belongs also heartburn, frequently occurring in dyspeptic patients, and caused by motility disturbances [1]. As a number of randomized controlled clinical trials have shown, the herbal medicine STW 5 (Iberogast ® ) is active not only in functional dyspepsia [2], but also in its symptom heartburn [3]. A systematic review, conducted with the aim to elucidate the underlying mode of action, has identified the following mechanisms: 1. Protection of the esophageal mucosa against acidic reflux: STW 5 inhibits mucosal inflammation in an experimental model of acid reflux [4]. 2. Enhancing of muscular tone of the lower esophageal sphincter, contributing to the inhibition of gastric reflux into the esophagus [5]. 3. Relaxation of fundus and corpus: This allows for a better adaptation of the volume to ingested food, thus reducing intragastric pressure [6,7] 4. Prokinetic effect on gastric antrum, improving gastric function. An onset of this effect within 10min after oral intake of STW 5 has been shown [6,7]. 5. Inhibition of increased acid secretion, thus potentially reducing the exposure of gastric and esophageal mucosa to acid. [8]. Possible mechanisms of action of STW 5, acting on multiple targets (explanation see text). References: [1] Tack, J. et al. (2006) Gastroenterology 130:1466–1479. [2] Schmulson, M.J. (2008) Nat. Clin. Pract. Gastr. 5:136–137. [3] Madisch, et al. (2007) Gut 56, SIII:A336. [4] Khayyal, M.T. et al. (2008) Neurogastroent. Motil. 20, S2:98. [5] Schemann, M. et al. (2008) Gastroenterol. 46:1039. [6] Schemann, M. et al. (2006) Phytomedicine 13:90–99. [7] Pilichiewicz, A.N. et al. (2006) Neurogastroent. Motil. 18:745. [8] Khayyal, M.T. et al. (2006) Phytomedicine 13:56–66.