The Efficacy of Cichorium intybus L., Trigonella foenum-graecum L. and Foeniculum vulgare Mill. in Improvement of Ulcerative Colitis Symptoms: A Randomized Clinical Trial
Abstract
Due to the lack of favorable response to synthetic drugs, the tendency to use traditional medicine to treat inflammatory bowel disease has risen. We aimed to assess the effect of Cichorium intybus L., Trigonella foenum-graecum L., and Foeniculum vulgare L. on the control of recurrent ulcerative colitis (UC) symptoms. This randomized clinical trial was performed on 60 patients suffering from mild-to-moderate UC. Patients were randomly assigned to control and intervention groups. Patients in both groups were treated with a standard dose of oral mesalazine (3 g daily) for eight weeks. In addition, the intervention group was given a mixture of 200 mg C. intybus, 350 mg T. foenum-graecum, and 1.5 mg F. vulgare (three times a day). The disease activity was evaluated before and 60 days after the intervention using a simple clinical colitis activity index (SCCAI). The baseline mean SCCAI score was similar in both groups. Although the SCCAI score significantly reduced in both groups 60 days after the initial assessment, this reduction was significantly higher in the group receiving the herbal combination than in the control group. The intervention-related side effects, such as bloating and dyspepsia, were well tolerated. The use of C. intybus, T. foenum-graecum, and F. vulgare can effectively control UC symptoms and thus, can be used as an effective and safe medication for treating UC.
Zhu M, Ran Z. Clinical characteristics of ulcerative colitis in elderly patients. JGH Open 2021;5:849-854.
Tsai L, Nguyen NH, Ma C, Prokop LJ, Sandborn WJ, et al. Systematic review and meta-analysis: Risk of hospitalization in patients with ulcerative colitis and crohn’s disease in population-based cohort studies. Dig Dis Sci 2021;67:2451-2461.
Casellas F, González-Lama Y, Vicens DG, García-López S, Muñoz F, et al. Adherence improvement in patients with ulcerative colitis: A multidisciplinary consensus document. Rev Esp Enferm Dig 2022;114:156-165
Kotze PG, Steinwurz F, Francisconi C, Zaltman C, Pinheiro M, et al. Review of the epidemiology and burden of ulcerative colitis in latin america. Therap Adv Gastroenterol 2020;13:1756284820931739.
Bernstein CN, Blanchard JF, Rawsthorne P, Wajda A. Epidemiology of crohn's disease and ulcerative colitis in a central canadian province: A population-based study. Am J Epidemiol 1999;149:916-924.
Blanchard JF, Bernstein CN, Wajda A, Rawsthorne P. Small-area variations and sociodemographic correlates for the incidence of crohn's disease and ulcerative colitis. Am J Epidemiol 2001;154:328-335.
Paridaens K, Fullarton JR, Travis SP. Efficacy and safety of oral pentasa (prolonged-release mesalazine) in mild-to-moderate ulcerative colitis: A systematic review and meta-analysis. Curr Med Res Opin 2021;37:1891-1900.
Li J, Wang F, Zhang H-J, Sheng J-Q, Yan W-F, et al. Corticosteroid therapy in ulcerative colitis: Clinical response and predictors. World J Gastroenterol 2015;21:3005.
Nwafor IC, Shale K, Achilonu MC. Chemical composition and nutritive benefits of chicory (cichorium intybus) as an ideal complementary and/or alternative livestock feed supplement. ScientificWorldJournal 2017;2017:7343928.
Janda K, Gutowska I, Geszke-Moritz M, Jakubczyk K. The common cichory (cichorium intybus l.) as a source of extracts with health-promoting properties—a review. Molecules 2021;26:1814.
Karimi MH, Ebrahimnezhad S, Namayandeh M, Amirghofran Z. The effects of cichorium intybus extract on the maturation and activity of dendritic cells. Daru 2014;22:28.
Olsen NJ, Branch VK, Jonnala G, Seskar M, Cooper M. Phase 1, placebo-controlled, dose escalation trial of chicory root extract in patients with osteoarthritis of the hip or knee. BMC Musculoskelet Disord 2010;11:156.
Schmidt BM, Ilic N, Kurmukov A, Raskin I. Chicory root extracts reduce inflammation in vivo. FASEB J 2006;20:LB122.
Yadav UC, Baquer NZ. Pharmacological effects of trigonella foenum-graecum l. In health and disease. Pharm Biol 2014;52:243-254.
Suresh P, Kavitha CN, Babu SM, Reddy VP, Latha AK. Effect of ethanol extract of trigonella foenum graecum (fenugreek) seeds on freund's adjuvant-induced arthritis in albino rats. Inflammation 2012;35:1314-1321.
Kawabata T, Cui M-Y, Hasegawa T, Takano F, Ohta T. Anti-inflammatory and anti-melanogenic steroidal saponin glycosides from fenugreek (trigonella foenum-graecum l.) seeds. Planta Med 2011;77:705-710.
Mandegary A, Pournamdari M, Sharififar F, Pournourmohammadi S, Fardiar R, et al. Alkaloid and flavonoid rich fractions of fenugreek seeds (trigonella foenum-graecum l.) with antinociceptive and anti-inflammatory effects. Food Chem Toxicol 2012;50:2503-2507.
Padmavathi G, JN NSC. Antiulcer activity of trigonella foenum-graecum leaves in cold restraint stress-induced ulcer model. Mol Clin Pharmacol 2012;3:90-91.
Swaroop A, Bagchi M, Kumar P, Preuss HG, Tiwari K, et al. Safety, efficacy and toxicological evaluation of a novel, patented anti-diabetic extract of trigonella foenum-graecum seed extract (fenfuro). Toxicol Mech Methods 2014;24:495-503.
Nathan J, Panjwani S, Mohan V, Joshi V, Thakurdesai PA. Efficacy and safety of standardized extract of trigonella foenum‐graecum l seeds as an adjuvant to l‐dopa in the management of patients with parkinson's disease. Phytother Res 2014;28:172-178.
Lu F-r, Shen L, Qin Y, Gao L, Li H, et al. Clinical observation on trigonella foenum-graecum l. Total saponins in combination with sulfonylureas in the treatment of type 2 diabetes mellitus. Chin J Integr Med 2008;14:56-60.
Swaroop A, Bagchi M, Preuss HG, Bagchi D. Safety and antidiabetic efficacy of a novel trigonella foenum-graecum seed extract. Nutritional and therapeutic interventions for diabetes and metabolic syndrome. Elsevier 2018; pp 357-364.
Rather MA, Dar BA, Sofi SN, Bhat BA, Qurishi MA. Foeniculum vulgare: A comprehensive review of its traditional use, phytochemistry, pharmacology, and safety. Arab J Chem 2016;9:S1574-S1583.
Rezayat SM, Dehpour A-R, Motamed SM, Yazdanparast M, Chamanara M, et al. Foeniculum vulgare essential oil ameliorates acetic acid-induced colitis in rats through the inhibition of nf-kb pathway. Inflammopharmacology 2018;26:851-859.
Malone HE, Nicholl H, Coyne I. Fundamentals of estimating sample size. Nurse Res 2016;23:21-25.
Ko CW, Singh S, Feuerstein JD, Falck-Ytter C, Falck-Ytter Y, et al. Aga clinical practice guidelines on the management of mild-to-moderate ulcerative colitis. Gastroenterology 2019;156:748-764.
Brayfield A. Martindale: The complete drug reference. PHP 2014.
Shishodia S, Aggarwal B. Diosgenin inhibits osteoclastogenesis, invasion, and proliferation through the downregulation of akt, iκb kinase activation and nf-κb-regulated gene expression. Oncogene 2006;25:1463-1473.
Langmead L, Dawson C, Hawkins C, Banna N, Loo S, et al. Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease: An in vitro study. Aliment Pharmacol Ther 2002;16:197-205.
Pandian RS, Anuradha C, Viswanathan P. Gastroprotective effect of fenugreek seeds (trigonella foenum graecum) on experimental gastric ulcer in rats. Journal of ethnopharmacology. 2002;81:393-397.
Choi E-M, Hwang J-K. Antiinflammatory, analgesic and antioxidant activities of the fruit of foeniculum vulgare. Fitoterapia 2004;75:557-565.
D'evoli L, Morroni F, Lombardi-Boccia G, Lucarini M, Hrelia P, et al. Red chicory (cichorium intybus l. Cultivar) as a potential source of antioxidant anthocyanins for intestinal health. Oxid Med Cell Longev 2013;2013:704310.
Files | ||
Issue | Vol 8, No 3, 2023 | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/tim.v8i3.13712 | |
Keywords | ||
Ulcerative colitis Complementary medicine Inflammatory bowel disease Cichorium intybus Trigonella foenum-graecum Foeniculum vulgare |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |