Herbal medicinal products and gastrointestinal motility: Mechanisms of action of STW 5

Introduction: Herbal medicinal products are in widespread use in motility-based gastrointestinal diseases, as e.g. the herbal combination product STW 5 with the indications functional dyspepsia (FD) and irritable bowel syndrome (IBS).

Aim: After a review of the clinical data has been published recently [1], a review also of the motility-related mechanisms of action is needed.

Methodik: A systematic database search was conducted and checked for completeness by means of hand searching and cross referencing.

Results: There is an increasing number of publications on the herbal components of the product. The first mechanistic studies on the combination [2, 3] showed a dual mechanism of action, with a spasmolytic effect in ACh induced contractions and a tonicising effect in relaxed state. This has been confirmed [4, 5], e.g. in human intestinal sections [6] and in inflamed intestinal sections in vitro and in vivo [7 – 9]. In the stomach, a region specific action was described in vitro [10], which has been confirmed in a human study in vivo [11]. In the lower esophageal sphincter, a tonicising action has been shown in vitro [6], which has not yet been confirmed in a human study.

Conclusions: The in vitro-, in vivo- and human studies showed spasmolytic as well as tonicing-prokinetic effects possibly relevant for the clinical effect of STW 5, while there are still questions open e.g. regarding the details of the cooperative effects of the components of the preparation.

References:

[1] Ottillinger et al. 2013, WMW 163:65

[2] Okpanyi et al. 1993, Acta Hort. 332:227

[3] Ammon et al. 2006, Phytomed 13 SV:67

[4] Heinle et al. 2006, Phytomed 13 SV:75

[5] Kelm et al. 2013, ZPT 34 S1:S31

[6] Schemann et al. 2008, Z Gastroenterol 46:1039

[7] Michael et al. 2009, Phytomed 16:161

[8] Sibaev et al. 2013, ZPT 34 S1:S31

[9] Wadie et al. 2012, Int J Colorectal Dis 27:1445

[10] Hohenester et al. 2004, Neurog Motil 2004, 16:765

[11] Pilichiewicz et al. 2007, Am J. Gastroenterol 102:1