Peppermint oil can provide relief for people with IBS who especially suffer from abdominal complaints. According to the working group, the positive effect on abdominal pain is small. But because the risk of side effects is also small, the NHG has chosen to recommend the treatment, possibly as a trial, for patients with IBS who have abdominal pain in the foreground.
It is advised to take the drug as gastro-resistant capsules (MSR). In this form, the release only takes place in the distal part of the small intestine. This gives a lower risk of irritation of the stomach and esophagus and therefore fewer heartburn and reflux complaints. To further reduce the risk of side effects, the NHG advises taking peppermint oil as an MSR on an empty stomach, thirty minutes before eating and with a large glass of cold water. The effect of the treatment is evaluated after eight weeks.
In the previous version of the standard from 2012, mebeverine and scopolamine butyl had a modest place in IBS with significant pain, as there was little or no evidence of efficacy. For the same reason, these agents are no longer recommended in the new standard. Furthermore, patients with pain complaints can use paracetamol. This advice has remained unchanged.
PDS-types
Roughly three forms can be distinguished from IBS, depending on the type of complaints. Complaints that arise from the intestines working too slowly are characterized by IBS with mainly constipation (IBS-C). If the intestines work too quickly and this causes complaints, this is referred to as IBS with diarrhea in the foreground (IBS-D). There is also a mixed form of IBS (IBS-M) in which diarrhea and constipation alternate in the foreground.