Effectiveness of Berberine hydrochloride in relieving IBS-D symptoms

Berberis aristata is only one of the 604 plant species, belonging to the Berberidaceae family, which populate the Berberis genus, and all characterized by the presence of berberine as an active compound.

Berberine is the isoquinoline alkaloid with an intense yellow color and a bitter taste, present in the bark, roots and stems of the plant, which is responsible for the benefits the plant can provide to our body.

Berberis Aristata in the Control of Gastrointestinal Disorders

Berberine has been traditionally used by Chinese medicine for the treatment of diarrhea.

Several studies have recognized its antidiarrheal effect, in particular in one of them, has been discovered a possible mechanism of action in which berberine seems to increase the expression of the Na + / H + 3 (NHE3) and aquaporin 4 (AQP4) exchanger, thus suggesting that it can exhibit its antidiarrheal action by partially increasing the absorption of Na + and water from the intestinal lumen. (Zhang et al., 2012)

When the alkaloid is present as it is, its powerful activity is limited by its poor oral bioavailability (Liu CS, Zheng YR, Zhang YF, Long XY,2016) not due to its poor direct absorption, but to its massive re-elimination in the intestinal lumen by specific transporters present on the cells of the intestinal mucosa (the ABC system). This is overcome when its saline form is used.

Irritable bowel syndrome (IBS) is a disorder that can also reduce patients' quality of life. Currently, the mechanism responsible for IBS is still not completely clear. However, impaired intestinal motility, visceral hypersensitivity, mucosal immune activation, increased mucosal permeability, enteric neuromuscular dysfunction, abnormal brain-gut interactions, altered gut microbiome, and psychological disturbances have been hypothesized as possible contributing causes of IBS. (Camilleri, 2013; Zheng and Tang, 2015).        

Effectiveness of Berberine hydrochloride in relieving IBS-D symptoms

A double-blind study has been realized on 132 patients diagnosed with IBS-D (irritable bowel syndrome with diarrhea) providing them 400 mg / day of Berberine Hydrochloride (divided into two oral administrations), or placebo for 8 weeks.

During the treatment period, each individual was asked to record daily cases of diarrhea, abdominal pain, frequency of defecation and any adverse events.

At the end of 8 weeks compared to baseline, in the treated group there was a significant reduction in the urge to defecate, in terms of:

? 70.3% reduction in the frequency of diarrhea.

? 64.6% reduction in the frequency of abdominal pain.

In addition, by monitoring the following weeks with follow-up at the 12th week, it was possible to see how the disorders, compared to the 8th week, began to increase again with the suspension of treatment.

To assess the frequency and severity of gastrointestinal symptoms, each participant was given several questionnaires, such as: IBS score, anxiety score, depression score, QOL score (quality of life scale), comparing the scores before and after treatment.

Compared to the baseline, we obtained:

? a 34.5% reduction in the IBS score,

? a 32.9% reduction in the anxiety score

? a 40.7% reduction in the depression score,

? a 29.7% increase in QOL scores.

The cited ?study has shown how berberine hydrochloride can relieve symptoms of gastrointestinal upset in patients diagnosed with IBS-D.

In addition, improvements in IBS, anxiety and depression scores suggest that the beneficial effects of berberine hydrochloride in IBS-D in the intestine may also be reflected in the central nervous system.

References

Chen C, Tao C, Liu Z, Lu M, Pan Q, Zheng L, Li Q, Song Z, Fichna J. A Randomized Clinical Trial of Berberine Hydrochloride in Patients with Diarrhea-Predominant Irritable Bowel Syndrome. Phytother Res. 2015 Nov;29(11):1822-7. doi: 10.1002/ptr.5475. Epub 2015 Sep 24. PMID: 26400188.

Camilleri M. 2013. Current and future pharmacological treatments for diarrhea-predominant irritable bowel syndrome. Expert Opin Pharmacother 14: 1151–1160.

Zhang Y, Wang X, Sha S, et al. 2012. Berberine increases the expression of NHE3 and AQP4 in sennosideA-induced diarrhoea model. Fitoterapia 83: 1014–1022.

Liu CS, Zheng YR, Zhang YF, Long XY. Research progress on berberine with a special focus on its oral bioavailability. Fitoterapia. 2016 Mar;109:274-82. doi: 10.1016/j.fitote.2016.02.001. Epub 2016 Feb 2. PMID: 26851175.