G. Pohl-Boskamp GmbH & Co. KG

Introduction Dyspeptic symptoms belong to the most frequent reasons to seek medical advice and are a burden both for the individual affected and the healthcare system. In Japan, the traditional herbal Kampo prescription rikkunshito has proven benefit for this indication. Methods In a prospective, multicentre, non-interventional study (NIS), the effectiveness, safety, and tolerability of a two-week treatment with the registered rikkunshito extract product YamatoGast was assessed in German patients with an acute episode of dyspeptic symptoms of functional origin under real-world conditions. The primary endpoint was the responsiveness to treatment assessed by the overall treatment effect (OTE) score. Secondary endpoints were the change in severity of dyspeptic symptoms and the change in quality of life (QoL). Safety evaluation was based on reported adverse drug reactions, drug compliance, and ratings of tolerability by physicians and patients. Results Sixty-six patients were enrolled (mean age 48.9 years, 74% females). The treatment was well tolerated and highly beneficial, as expressed by pronounced responder rates of 78.9% for the primary endpoint OTE. All secondary endpoints were also met. The severity of dyspeptic symptoms significantly improved by 62–77% compared to baseline, confirmed by a remarkable improvement of QoL. Significant symptom relief started from the third day of treatment onwards. Conclusion In this non-interventional study, two-week treatment with YamatoGast resulted in a significant improvement of dyspeptic symptoms and was associated with high patient response and satisfaction. YamatoGast was confirmed as a safe and clinically relevant therapeutic option for patients suffering upper gastrointestinal complaints in routine practice.

Tinnitus, the phantom perception of sounds, generates distress and anxiety in those affected. Cognitive behavioral treatment approaches reproducibly help patients in managing chronic tinnitus. This study systematically evaluated the usefulness of a tinnitus app (with areas of attention and relaxation, mindfulness, acceptance, self-efficacy), which is prescribed for a total of nine months. One hundred eighty-seven participants with chronic tinnitus were equally randomized to an intervention arm that used a smartphone-based intervention -marketed as Kalmeda Tinnitus app-. and a control arm with delayed onset of treatment by 3 months. The first 3 months of a 9-months prescribed intervention have been analyzed as primary outcome. The Tinnitus Questionnaire (TQ) was used as primary endpoint to determine the reduction of tinnitus distress. Following intervention, there was a statistically significant and clinically relevant reduction of the TQ sum score in the intervention group compared to the control group (p<0.001, Cohen's d effect size = 1.1). The secondary parameters, Patient Health Questionnaire-9 (PHQ9) and Perceived-Stress-Questionnaire (PSQ20) scores improved significantly in the intervention group whereas the Self Efficacy-Optimism-Pessimism short form (SWOP-K9) scores remained unchanged in both groups. Patients reported no treatment-related side effects. Taken together, use of this Tinnitus app lead to a significant decrease in tinnitus distress and a clinically relevant effect in the patients´ self-reported everyday management.

Pyrrolizidine alkaloids are naturally occurring toxins produced by certain weeds that can, if accidentally co-harvested, contaminate plant-based food, feed, and herbal medicinal products. Focusing on herbal medicinal products, the presence of pyrrolizidine alkaloids is restricted by regulatory prescribed thresholds to assure patient safety. Among the multitude of different herbal active substances utilized in herbal medicinal products, the class of pharmaceutically effective essential oils is considered to exhibit a negligible contribution to pyrrolizidine alkaloid contamination. Within the present investigation, this hypothesis should be scientifically scrutinized. For this purpose, an experimental set-up was chosen that reproduces the typical manufacturing step of hydrodistillation. Essential oils of eucalyptus and lemon were selected exemplarily and spiked with 3 representative pyrrolizidine alkaloids (retrorsine, retrorsine-N-oxide, and lycopsamine), whereupon hydrodistillation was performed. Analysis of the resulting distillates by LC-MS/MS proved that artificially added pyrrolizidine alkaloids were removed completely. Moreover, quantitative pyrrolizidine alkaloid recovery in the aqueous phases was observed. Hence, it was experimentally confirmed that herbal medicinal products employing hydrodistilled essential oils of pharmaceutical quality are intrinsically free of pyrrolizidine alkaloids due to the particularities of their manufacturing process. Furthermore, it can be concluded from theoretical considerations that essential oils produced by cold pressing have a negligible risk of carrying pyrrolizidine alkaloid contamination. Our findings provide a strong indication that the requirement for analytical pyrrolizidine alkaloid testing of essential oils for pharmaceutical use should be fundamentally reconsidered.