Abstract:Age-related diseases like dementia are increasing globally, with limited treatments. Extracts of Ginkgo biloba are often used alongside synthetic drugs. The aim of this article was to identify clinical guidelines from countries around the world to assess recommendations on the use of Ginkgo biloba in dementia, mild cognitive impairment, and prevention. PubMed was systematically searched for guidelines on dementia and mild cognitive impairment on the 25th of April 2023. A search update was conducted on the 3rd of March 2026. Additional guidelines were identified via citation searching and organisations. Seventy-seven guideline documents were included: 47 on dementia (subtype not further defined), 25 on Alzheimer's disease, 19 on vascular dementia, 18 on mild cognitive impairment, and seven on prevention, with some guidelines including multiple mentions. The guidelines come from four continents and 28 countries, plus seven international guidelines. Regarding Ginkgo biloba, 52 give positive, 18 negative, and 26 neutral recommendations (double mentions possible); 27 do not mention it. Ginkgo biloba is referred to in guidelines worldwide, usually without reference to specific preparations. Preparation standardisation would be beneficial.

ObjectiveTo define the potential functional roles of a herbal preparation of myrrh, chamomile extract, and coffee charcoal in patients suffering from diarrhea dominant irritable bowel syndrome (IBS-D).MethodsThe study utilized the Mucosal Simulator of the Human Intestinal Microbial Environment (M-SHIME®) with proximal (PC) and distal colon (DC) compartments and fecal samples from four IBS-D donors. Eight-day (d) repeated dosing with the herbal product (6 tablets/day) was initiated compared to a negative control. Changes in microbial metabolism and community composition were assessed, and colonic ferments were evaluated for their effects on intestinal barrier permeability and cytokine production in a Caco-2/THP-1 co-culture model.ResultsProduct treatment significantly increased gas pressure versus negative control, indicating microbial fermentative activity. Product supplementation significantly increased proximal acetate (d3, d5), propionate (d3), and butyrate (d5, d8) levels (p < 0.05 for all), while no significant changes were observed distally. Ammonium levels were significantly elevated following product supplementation in PC (d3, d5, d8; p < 0.05) and DC (d8; p < 0.01), though remained within physiological range. Repeated dosing enriched members of Bifidobacteriaceae, Bacteroidota, Lachnospiraceae, and Butyricicoccus versus negative control. Treated colonic ferments had a protective effect on intestinal membrane integrity (DC; p < 0.001) and positive immunomodulatory effects (increased IL-10, PC and DC [both p < 0.0001], and IL-6, PC [p < 0.001] and DC [p < 0.01]) in Caco-2/THP-1 co-cultures.ConclusionsTreatment with a herbal preparation of myrrh, chamomile extract, and coffee charcoal showed a potential beneficial effect on the microbiota of patients with IBS-D in vitro, suggesting further exploration of its efficacy in IBS-D and other chronic gastrointestinal disorders.

Functional dyspepsia is common and classified as a disorder of gut-brain interaction (DGBI). The prevalence is estimated around 10 % of the population. Diagnosis is based on symptoms, which are based on the Rome IV criteria, in combination with diagnostic procedures that may include laboratory testing, Helicobacter pylori testing, upper gastrointestinal endoscopy, abdominal ultrasound, and other examinations, depending on the severity, duration and presence of alarming symptoms. Therapeutic procedures include psychoeducation, dietary counseling, mind-body procedures, psychotherapy and medication. The S1 guideline summarizes the current state of knowledge and allows a targeted approach based on the currently available medical evidence.

Recurring pain is a debilitating symptom in inflammatory bowel disease (IBD), often persisting beyond acute gut inflammation with unclear underlying mechanisms. Altered emotional reactivity to pain has been proposed as a key contributor to pain persistence, but experimental evidence is scarce. This study investigated whether pain-related fear learning shapes the perception of acute experimental pain in quiescent IBD. Implementing a 2-day differential fear conditioning paradigm, we assessed the acquisition and extinction of conditioned fear in response to nociceptive (thermal pain) and non-nociceptive (aversive tones) unconditioned stimuli (US) in IBD patients and healthy controls. After overnight consolidation, US re-exposure was evaluated, focusing on pain intensity and unpleasantness ratings. Compared with healthy volunteers, IBD patients exhibited significantly enhanced pain intensity and unpleasantness upon re-exposure to pain, correlating with the magnitude of pain-related fear learning the day before. The relationship between fear learning and pain intensity was fully mediated by pain unpleasantness, suggesting a key role of the emotional valence of pain. Notably, behavioral measures of fear acquisition and extinction were unaltered in patients, pointing toward pain-related central adaptations rather than exaggerated fear acquisition as the underlying mechanism. These findings identify fear-induced hyperalgesia as a potential central mechanism contributing to persistent pain in IBD and highlight the importance of targeting conditioned fear in future personalized interventions to fill the current therapeutic gap in IBD-related pain.

Background: Crohn's disease (CD) significantly affects patients' well-being and is influenced by stress and lifestyle factors, highlighting the importance of improving quality of life in CD management. An imbalance between pro- and anti-inflammatory CD4(+) T cell responses is a key factor in CD, and stress has been shown to alter the function of CD4(+) T cells. Therefore, this study aimed to evaluate the effect of a mind-body medicine stress management and lifestyle modification (MBM) program on the CD4(+) T cell profile in CD patients. Methods: Circulating CD4(+) T cells from CD patients were analyzed by flow cytometry following the MBM program. Patients were randomly assigned to either a guided intervention group (IG) or a self-guided waitlist control group (CG) over a 9-month trial and compared with healthy blood donors. Results: Lifestyle intervention reduced regulatory T cell (Treg) frequencies in the blood of CD patients. Notably, we observed a significant correlation between the quality of life improvement and Treg frequencies in the IG but not in the CG. Furthermore, differential activation and expression of the gut-homing molecules G protein-coupled receptor 15 and CCR9 on circulating Tregs and CD4(+) effector T cells were detected in both the IG and CG. Conclusions: The MBM program, whether guided or self-directed, has the potential to restore the CD4(+) T cell profile of CD patients to levels comparable to healthy blood donors. Lifestyle interventions may benefit CD progression, symptoms, and immunological status, but further analysis is needed to substantiate these findings and to fully understand their clinical implications. (ClinicalTrials.gov: NCT05182645).

In disorders of gut–brain interaction including functional dyspepsia and irritable bowel syndrome, clinical focus has shifted from pathophysiological criteria to symptoms. A single-arm, low-intervention clinical trial into the effectiveness and tolerability of Menthacarin, a peppermint oil/caraway oil combination, was performed. A total of 126 patients with abdominal pain/cramps or a sensation of being bloated without organic cause received 1 capsule Menthacarin twice a day for 8 weeks. Assessments included abdominal symptoms, stool parameters, and quality of life. During treatment, all assessed abdominal symptoms showed significant (p < 0.001), clinically meaningful improvements, with standardized effect sizes of 0.83–1.05 for change from baseline. The number of days/week with symptom impact or incomplete spontaneous bowel movements almost halved, while days/week with normal stool consistency increased (all p < 0.001). Health-related quality of life significantly improved (p < 0.001) and Menthacarin was well tolerated. The study demonstrates patient-relevant improvement in gastrointestinal symptoms during treatment with Menthacarin while underlining its favorable tolerability profile.

INTRODUCTION:In disorders of gut-brain interaction including functional dyspepsia and irritable bowel syndrome, clinical focus has shifted from pathophysiological criteria to symptoms. METHODS:A single-arm, low-intervention clinical trial into the effectiveness and tolerability of Menthacarin, a peppermint oil/caraway oil combination, was performed. A total of 126 patients with abdominal pain/cramps or a sensation of being bloated without organic cause received 1 capsule Menthacarin twice a day for 8 weeks. Assessments included abdominal symptoms, stool parameters, and quality of life. RESULTS:During treatment, all assessed abdominal symptoms showed significant (p < 0.001), clinically meaningful improvements, with standardized effect sizes of 0.83-1.05 for change from baseline. The number of days/week with symptom impact or incomplete spontaneous bowel movements almost halved, while days/week with normal stool consistency increased (all p < 0.001). Health-related quality of life significantly improved (p < 0.001) and Menthacarin was well tolerated. CONCLUSION:The study demonstrates patient-relevant improvement in gastrointestinal symptoms during treatment with Menthacarin while underlining its favorable tolerability profile.

BACKGROUND:Ginkgo biloba leaf extract EGb 761® might have diverse therapeutic effects. OBJECTIVE:We conducted an overview of systematic reviews (SRs) to compile the efficacy and safety of EGb 761®. METHODS:The Cochrane Database of Systematic Reviews, MEDLINE (via PubMed), Embase (via OVID) and PROSPERO were searched from inception until July 25th, 2023 with an update on January 30th, 2025. SRs were included if they evaluated the efficacy and safety of oral treatment with EGb 761® under any clinical condition or in healthy subjects for clinical reasons, such as prevention, or for health promotion. Two authors carried out screening, selection, data extraction and risk of bias assessment (AMSTAR 2). The degree of overlap was quantified. The overview was registered a priori (PROSPERO: CRD42023423789). RESULTS:We screened 126 articles and included reviews on neurocognitive disorders (n = 13), tinnitus, macular degeneration and schizophrenia (all n = 1). For neurocognitive disorders, most SRs were in favor of EGb 761® regarding cognition and behavioral and/or psychological symptoms, while the results for functional activities of daily living varied. EGb 761® might have positive effects on tinnitus, macular degeneration or schizophrenia: however, more evidence is needed. In general, EGb 761® appears to be safe. Methodological quality was poor in all SRs. The overall overlap of the primary studies on neurocognitive disorders was very high, and pairwise overlap varied. CONCLUSION:EGb 761® has been studied in various reviews, particularly regarding neurocognitive disorders and has been reported to be safe in many SRs. The results must be treated with caution due to the poor quality of the SRs.

Die funktionelle Dyspepsie (FD), der Reizmagen, ist eine häufige Erkrankung und wird zu den Erkrankungen der Darm-Hirn-Interaktionsstörungen, den Disorders of Gut-Brain Interaction (DGBI) gezählt. Die Prävalenz wird mit etwa 10 % der Bevölkerung angegeben. Die Diagnostik erfolgt anhand symptombezogener Kriterien, die sich an den Rom-IV-Kriterien orientieren, in Kombination mit diagnostischen Verfahren, die je nach Symptomausprägung, Dauer und alarmierenden Symptomen Labor, Helicobacter Pylori-Testung, Gastroskopie, Sonografie und weitere Untersuchungen beinhalten. Therapeutische Verfahren umfassen Maßnahmen der Psychoedukation, Ernährungsangebote, Mind-Body-Verfahren, Psychotherapie und medikamentöse Optionen. Die S1-Leitlinie fasst den aktuellen Wissensstand zusammen und erlaubt ein zielgerichtetes Vorgehen, basierend auf der aktuell verfügbaren medizinischen Evidenz.