Iberogast® for Healthcare Professionals

Benefits of Multi-Target Therapy

Patients suffering from Functional Gastrointestinal Disorders (FGIDs) may be unhappy about taking several medicines in order to treat different symptoms. They may also be concerned about interactions and potential side effects. These patients may benefit from a multi-target therapy which is plant-based, works on multiple symptoms and has no known drug interactions.

A multi-targeted approach

FGIDs continue to remain a therapeutic challenge due to their diverse symptomatology and the lack of a single cause or target for drug intervention. Usually, pharmacological treatment of Irritable Bowel Syndrome varies from antidepressants and prokinetic drugs to antispasmodics.

Yet synthetically derived monodrugs are affecting mainly just one cause and may not relieve the maltitude of symptoms. In contrast, Iberogast uses a unique formulation: a multi-target herbal therapy. This treatment concept allows treating a multi-causal disease with a multi-effect combination, working on the different functional causes and symptoms. The use of Iberogast for the treatment of IBS in adults is recommended by the German Society of Digestive and Metabolic Diseases (DGVS).11

Iberogast is registered as an OTC medicine for the treatment of IBS and FD

With its nine active herbal extracts, Iberogast targets multiple malfunctions of the gastrointestinal system and effectively relieves the associated symptoms.26 By acting specifically on diverse targets, the ingredients support each other and add up to more than the sum of the individual effects: they are hyperadditive or synergistic.27

HCP-gastric-diagram-acting

Nine active medicinal herbs

The nine medicinal plants of Iberogast are grown, harvested and processed under controlled conditions. Moreover, rigorous quality controls ensure constant concentrations of the specific hydroethanolic extracts in the final product.10 The active herbal substances work in parallel at different sites of action:

Explore the 9 medicinal herbs that make Iberogast effective

Iberogast: Modes of action

How does Iberogast influence the different malfunctions of FGIDs?
Malfunction Iberogast® ...
1. Hypermotility / Increased motility ...relaxes gastrointestinal muscles = anti-cramping
2. Hypomotility / Decreased motility ...activates gastrointestinal muscles = normalizing GI transport, prokinetic
3. Hypersensitivity ...reduces hypersensitivity = nerve calming, pain reducing
4. Excess gas formation ...reduces flatulence = anti-bloating, carminative
5. Inflammation ...has anti-oxidative effects = anti-inflammatory, pain reducing
  • Iberogast has an effect on the muscle movement of the gastrointestinal system. It relaxes the cramped muscles that prevent the stomach from accommodating the food: corpus and fundus tension is released. Subsequently, the stomach can better adapt its volume to ingested food.

    Iberogast can normalise distension and relax abdominal cramps

    Depending on its dose, lberogast evokes a sustained and reversible relaxation of gastric corpus and fundus muscles in vitro.7 Where muscles are overly contracted, Iberogast can relax cramping and enable normal stomach function.

    Pilichiewicz et al. (2007) revealed that Iberogast increases the proximal stomach volume by relaxing corpus and fundus in humans as well.18 This was shown in the Intra-bag volume test.

    HCP-intra-bag-volume-graph

    Intra-bag Volume test

    FIGURE 1. Intrabag volume, as mean of 10-minute segments, after oral administration of 1.1 mL control solution or Iberogast, with 50mL water. Iberogast increased intrabag volume when compared with control (*P < 0.05 vs control). Data are mean ± SEM (N = 9).

    Note - the Australian adult dose for Iberogast is 1mL.

    Iberogast has substantial intestinal spasmolytic effects

    Heinle et al. (2006) demonstrated that the effect of Iberogast on histamine-induced smooth muscle contractions corresponds to approx. 10 μM of papaverine that means that Iberogast exerts a substantial spasmolytic activity.6

    Effects of STW5 and its components on histamine-induced contraction in guinea pig ileum

    Extract Force of histamine-induced contraction (control = 100% in each case)
    N Mean value S.D. P
    Angelicae radix 8 53.7 17.6 *
    Silybi mariani fructus 10 72.0 31.0 n.s.
    Carvi fructus 7 84.5 12.6 *
    Chelidonii herba 10 102.9 27.8 n.s.
    Iberis amara totalis 8 88.0 21.6 n.s.
    Liquiritiae radix 8 79.9 24.8 *
    Matricariae flos 7 64.1 18.0 *
    Melissae folium 7 64.1 18.0 *
    Menthae piperitae folium 9 75.0 18.9
    STW 5 (Iberogast) 6 76.5 9.6 *
    Papaverine (10µM)
    Papaverine (50µM)
    4
    4
    81.5
    31.4
    5.7
    11.2
    *
    **

    Adapted from Heinle et al. 2006

  • Iberogast has a dual effect on the muscle movement of the gastrointestinal tract.7,24 It not only relaxes the muscles that prevent the stomach from accommodating the food, it also stimulates the muscles that are too limp to move the food forward towards the intestine – thus normalising GI transport and preventing the feeling of fullness.

    In particular Iberogast increases the muscle tone in the antrum of the stomach to help improve meal transportation.

    When the stomach is over-relaxed, food remains in the stomach too long and is not transported onwards. Pressure builds in the stomach and intestine due to decreased transit.

    IMAGE-Study1_mod4

    Over-relaxed

    IMAGE-Study1_mod1

    Normal

     

    Iberogast shown to stimulate antral motility in humans

    Pilichiewicz et al. (2007) demonstrated an increase in the phasic activity of the antrum. The motility index of antral pressure waves in the first 60 minutes was increased. The gastric emptying of solids or intragastric distribution was not affected.

    HCP-antral-motility

    Motility index (MI) of antral pressure waves, as a mean of 10-minute segments, after oral administration of 1.1 ml control solution or Iberogast®, with 50 ml water. Iberogast® increased antral motility between 0 and 60 minutes significantly when compared with control (*P < 0.01). Data represents mean ± SEM (N = 12

    Note - the Australian adult dose for Iberogast is 1mL.

    Adapted from Pilichiewicz et al. 2007

  • Iberogast normalises the perception of pain by lowering the sensitivity of ‘hyperactive’ nerves to pain stimuli.12

    Iberogast can calm GI nerves and reduces pain

    Neurological studies show that Iberogast decreases GI pain signals generated in response to physical and inflammatory stimuli. Specifically Iberogast reduced sensitivity to neural stimuli:

    • after tension stimulus
    • after application of serotonin
    • after application of bradykinin
    HCP-gi_nerves

    Adapted from Liu et al. 2004

  • As demonstrated by Harries et al. (1978), Ritter et al. (1993) and Brendler et al. (2005) the extracts from Peppermint, Caraway, Lemon balm and Greater celandine have anti-gas effects.

    Harries et al. (1978) used an apparatus for generating and assessing foams in digestive fluids in vitro. The anti-foaming and carminative effects of peppermint, caraway and other volatile oils on gastric and intestinal foams were proven.

    HCP-reduces

    Volatile oils show reducing effects on foam heights of simulated gastric juice; Adapted from Harries et al. (1978) 32

  • The extracts of Bitter candytuft, Caraway, Liquorice, Peppermint, St Mary's thistle, Greater celandine and Lemon balm in Iberogast have anti-inflammatory effects on the gastrointestinal tract to relieve symptoms of FGIDs.5,16,22
    Most patients perceive a significant reduction of pain as the most notable relief.13

    The anti-inflammatory action of Bitter candytuft has been shown in vivo in the carrageenan-induced inflammation model of the rat (indomethacin as positive control).

    In particular, the marked radical scavenging properties of Iberogast results in the anti-inflammatory effect: its herbs reduce the formation of free radicals which are released in inflamed tissue.

    This was investigated in a series of test systems where reactive oxygen species (ROS) were generated, similar to the conditions in inflamed tissue.22

    HCP-anti_oxidative

    Antioxidative effects in the lung model: the bars represent the remaining production of free radicals after addition of the extracts (final concentration 9.8 µl / ml assay volume) with respect to the controls. Mean values ±SD, n = 3-4 in each case; controls were performed during all experiments.

    Adapted from Germann et al. 2006