Extract from Aloe barbadensis in the Treatment of Irritable Bowel Syndrome

Extract from Aloe in the Treatment of IBS

Two randomized controlled trials demonstrated the safety and good tolerability of aloe extract in patients with IBS and a trend towards symptom severity reduction in some subgroups when aloe extract was added to inulin. However, individual studies lacked sufficient power to show a statistically significant therapeutic benefit of aloe extract. Swedish authors therefore conducted a post hoc analysis of pooled data from these two studies of their own. The aim was to evaluate the effect of aloe extract on the change in IBS symptom severity compared to the baseline of the study and the proportion of patients with a response to treatment.

Study Methods

Both studies included adult patients meeting Rome III criteria for IBS. They were randomized to receive effervescent tablets with aloe extract (500 mg of aloe and 780 mg of inulin/day) or control treatment (1280 mg of inulin/day) for 4 weeks. The aloe extract contained in the tablets was a lyophilized extract of gel from the leaves of Aloe barbadensis with a polysaccharide complex containing < 0.1 ppm of aloin, a known laxative component of aloe.

At the beginning and end of treatment, patients filled out the IBS Severity Scoring System (IBS-SSS) questionnaire, a 2-week stool diary (using the Bristol Stool Form scale), and the Hospital Anxiety and Depression scale (HAD). The primary endpoints were the change in IBS-SSS score at the end of treatment compared to the baseline of the study and the proportion of patients with a response to treatment in subgroups with different subtypes of IBS, disease severity, and the presence/absence of psychological stress. A treatment response was defined as a decrease in IBS-SSS score of at least 50 points compared to the baseline of the study.

Results

Data from 213 IBS patients were analyzed. In 71 patients with diarrhea-predominant IBS (IBS-D), a significantly greater reduction in overall symptom severity was observed with aloe extract treatment compared to the control group. This difference was mainly due to a decrease in the intensity and frequency of pain. It was significant with aloe extract treatment compared to the baseline of the study (p < 0.001) and compared to the control group (p = 0.01). A greater proportion of patients with a response to treatment was also observed with aloe extract (58%) than in the control group (30%). Aloe extract did not affect stool frequency and consistency, which were comparable in both IBS-D groups.

Conclusion

Although aloe extract did not affect stool characteristics, it led to a reduction in the intensity and frequency of pain in patients with diarrhea-predominant irritable bowel syndrome. According to the authors, the results are clinically relevant not only because patients with IBS-D represent about one-third of IBS patients, but also because abdominal pain is a diagnostic criterion for IBS, one of its main symptoms, and a significant predictor of the overall severity of IBS. It is also the most common symptom for which IBS patients seek medical help.

(zza)

Source: Ahluwalia B., Magnusson M. K., Böhn L. et al.Aloe barbadensis Mill. extract improves symptoms in IBS patients with diarrhoea: post hoc analysis of two randomized double-blind controlled studies. Therap Adv Gastroenterol 2021 Oct 8; 14: 17562848211048133, doi: 10.1177/17562848211048133.