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| ID | Type | Description | Link |
|---|---|---|---|
| 2015-005467-16 | EudraCT Number |
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| Name | Class |
|---|---|
| ZonMw: The Netherlands Organisation for Health Research and Development | OTHER |
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Peppermint oil has shown to be effective in the treatment of Irritable Bowel Syndrome (IBS) symptoms in several meta-analyses. However, the level of evidence is moderate and peppermint oil remains relatively under-used in IBS. Therefore, the investigators will conduct a multicenter randomized, placebo controlled trial to investigate the effects of an eight-week peppermint oil treatment in IBS patients according to current European Medicines Agency (EMA) / US Food and Drug Administration (FDA) guidelines. To improve efficacy and to reduce side effects, the investigators aim to study the use of a new peppermint oil formulation, a colon-targeted-delivery capsule that will release the oil in the (ileo-) colonic region specifically.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ileocolonic release peppermint oil | Experimental | Colon-targeted-delivery capsule containing 182mg of Peppermint Oil, to be taken orally, 3 times daily for 8 weeks (first week, dosing will be titred). |
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| Small intestinal release peppermint oil (Tempocol®) | Experimental | Enteric-coated capsule containing 182mg of Peppermint Oil that release the oil in the small intestine, to be taken orally, 3 times daily for 8 weeks (first week, dosing will be titred). |
|
| Placebo | Placebo Comparator | Capsule containing microcrystalline cellulose, to be taken orally, 3 times daily for 8 weeks (first week, dosing will be titred). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ileocolonic release peppermint oil | Drug | Peppermint oil, menthae piperitae aetheroleum |
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| Measure | Description | Time Frame |
|---|---|---|
| Abdominal pain response rate after 8 weeks of treatment | A responder is defined as a patient who experiences at least a 30 percent decrease in the weekly average of worst daily abdominal pain (measured daily, on an 11 point NRS) compared to baseline weekly average in at least 50 percent of the weeks in which the treatment in given. | 8 weeks |
| Degree of relief response rate after 8 weeks of treatment. | A responder is defined as a patient who experiences a weekly relief of 1 or 2 (on a 7 point NRS) in at least 50 percent of the weeks in which treatment is given. | 8 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Global symptom improvement | As determined by IBS-SSS (IBS symptom severity scale) | 8 weeks |
| Abdominal Discomfort | As determined by symptom diary |
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Inclusion Criteria:
Age between 18 and 75 years;
Diagnosed with Irritable Bowel Syndrome according to the Rome IV criteria:
(Recurrent abdominal pain, at least 1 day/week for the last 3 months; Symptom onset at least 6 months prior to diagnosis; Associated with two or more of the following:
Based on the medical history and previous examination, no other causes for the abdominal complaints can be defined. Especially no history of:
Women in fertile age (<55 years old) must use contraception or be postmenopausal for at least two years.
Average worst abdominal pain score (on 11-point NRS) of > 3, during the two-week run-in period.
Exclusion Criteria:
Insufficient fluency of the Dutch language;
Any previous use (also incidental use) of peppermint oil capsules in the last 3 months prior to inclusion (the use of peppermint tea, menthol candy etc. is allowed);
The inability to stop regular use of medication affecting the gastro-intestinal system (such as Non Steroidal Anti Inflammatory Drugs (NSAID), laxatives, prokinetics, opioids, smasmolytics and anti-diarrhoeal drugs). This use should be halted at least 1 week before enrollment into the run-in period;
Previous major abdominal surgery or radiotherapy interfering with gastrointestinal function:
History of liver disease, cholangitis, achlorhydria, gallstones or other diseases of the gallbladder/biliary system;
Pregnancy, lactation;
Using drugs of abuse;
Known allergic reaction to peppermint.
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| Name | Affiliation | Role |
|---|---|---|
| A Masclee, Prof., PhD., MD. | Maastricht University Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Gelderse Vallei Hospital | Ede | Gelderland | 6716 RP | Netherlands | ||
| Medical Center Leeuwarden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20621586 | Background | Schellekens RC, Stellaard F, Olsder GG, Woerdenbag HJ, Frijlink HW, Kosterink JG. Oral ileocolonic drug delivery by the colopulse-system: a bioavailability study in healthy volunteers. J Control Release. 2010 Sep 15;146(3):334-40. doi: 10.1016/j.jconrel.2010.05.028. Epub 2010 May 31. | |
| 24096020 | Background |
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| Placebo | Drug | Placebo capsule, containing microcrystalline cellulose |
|
| Small intestinal release peppermint oil | Drug | Peppermint oil, menthae piperitae aetheroleum |
|
|
| 8 weeks |
| Bloating | As determined by IBS-SSS (IBS - symptom severity scale) | 8 weeks |
| Regurgitation | As determined by symptom diary | 8 weeks |
| Nausea | As determined by symptom diary | 8 weeks |
| Urgency | As determined by symptom diary | 8 weeks |
| Abdominal cramps | As determined by symptom diary | 8 weeks |
| Average stool frequency and consistency | Measured by bristol stool chart | 8 weeks |
| Indirect costs | Determined by Production Cost Questionnaire (PCQ) questionnaire | 8 weeks, 3 and 6 months |
| Direct costs | Determined by Medical Cost Questionnaire (MCQ) questionnaire | 8 weeks, 3 and 6 months |
| General Quality of Life | As determined by Euro-Qol-5D (EQ-5D) | 8 weeks, 3 and 6 months |
| IBS related Quality of Life | As determined by IBS-Quality of life questionnaire (IBS-QoL) | 8 weeks, 3 and 6 months |
| Use of Over the counter medication and rescue medication | Number of drugs taken as rescue medication (This is not an intervention) | 8 weeks |
| Number and severity of side effects | Determined by daily diary | 8 weeks |
| Responder rates following discontinuation of treatment at 3 and 6 months, different thresholds for the responder analysis of abdominal pain (e.g. 40 and 50 percent improvement); | 3 and 6 months after discontinuation of treatment |
| Responder rates when missing are interpreted as "no effect" | 8 weeks |
| Leeuwarden |
| Provincie Friesland |
| 8934 AD |
| Netherlands |
| Alrijne Hospital | Leiden | South Holland | 2334 CK | Netherlands |
| Maastricht University Medical Center | Maastricht | 6229 ER | Netherlands |
| Maurer JM, Schellekens RC, van Rieke HM, Stellaard F, Wutzke KD, Buurman DJ, Dijkstra G, Woerdenbag HJ, Frijlink HW, Kosterink JG. ColoPulse tablets perform comparably in healthy volunteers and Crohn's patients and show no influence of food and time of food intake on bioavailability. J Control Release. 2013 Dec 28;172(3):618-24. doi: 10.1016/j.jconrel.2013.09.021. Epub 2013 Oct 2. |
| 24100754 | Background | Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014 Jul;48(6):505-12. doi: 10.1097/MCG.0b013e3182a88357. |
| 21389791 | Background | Enck P, Junne F, Klosterhalfen S, Zipfel S, Martens U. Therapy options in irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2010 Dec;22(12):1402-11. doi: 10.1097/MEG.0b013e3283405a17. |
| 19008265 | Background | Ford AC, Talley NJ, Spiegel BM, Foxx-Orenstein AE, Schiller L, Quigley EM, Moayyedi P. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008 Nov 13;337:a2313. doi: 10.1136/bmj.a2313. |
| 30284674 | Background | Weerts ZZRM, Keszthelyi D, Vork L, Aendekerk NCP, Frijlink HW, Brouwers JRBJ, Neef C, Jonkers DMAE, Masclee AAM. A Novel Ileocolonic Release Peppermint Oil Capsule for Treatment of Irritable Bowel Syndrome: A Phase I Study in Healthy Volunteers. Adv Ther. 2018 Nov;35(11):1965-1978. doi: 10.1007/s12325-018-0802-1. Epub 2018 Oct 4. |
| 34468079 | Derived | Weerts ZZRM, Essers BAB, Jonkers DMAE, Willems JIA, Janssen DJPA, Witteman BJM, Clemens CHM, Westendorp A, Masclee AAM, Keszthelyi D. A trial-based economic evaluation of peppermint oil for the treatment of irritable bowel syndrome. United European Gastroenterol J. 2021 Nov;9(9):997-1006. doi: 10.1002/ueg2.12134. Epub 2021 Sep 1. |
| 31470006 | Derived | Weerts ZZRM, Masclee AAM, Witteman BJM, Clemens CHM, Winkens B, Brouwers JRBJ, Frijlink HW, Muris JWM, De Wit NJ, Essers BAB, Tack J, Snijkers JTW, Bours AMH, de Ruiter-van der Ploeg AS, Jonkers DMAE, Keszthelyi D. Efficacy and Safety of Peppermint Oil in a Randomized, Double-Blind Trial of Patients With Irritable Bowel Syndrome. Gastroenterology. 2020 Jan;158(1):123-136. doi: 10.1053/j.gastro.2019.08.026. Epub 2019 Aug 27. |
| ID | Term |
|---|---|
| D043183 | Irritable Bowel Syndrome |
| D015746 | Abdominal Pain |
| D003109 | Colonic Diseases, Functional |
| ID | Term |
|---|---|
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012817 | Signs and Symptoms, Digestive |
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