Antispasmodic Remedies for Digestive Disorders -
Functional bowel disorders and functional abdominal pain. Olden KW. Irritable bowel syndrome: an overview of diagnosis and pharmacologic treatment. Cleve Clin J Med. American College of Gastroenterology Functional Gastrointestinal Disorders Task Force.
Evidence-based position statement on the management of irritable bowel syndrome in North America. Am J Gastroenterol. Talley NJ, Spiller R. Irritable bowel syndrome: a little understood organic bowel disease?. Nanda R, James R, Smith H, Dudley CR, Jewell DP.
Food intolerance and the irritable bowel syndrome. Friedman G. Diet and the irritable bowel syndrome. Gastroenterol Clin North Am. Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, et al. Systematic review on the management of irritable bowel syndrome in North America.
Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med. Parisi GC, Zilli M, Miani MP, Carrara M, Bottona E, Verdianelli G, et al.
High-fiber diet supplementation in patients with irritable bowel syndrome IBS : a multicenter, randomized, open trial comparison between wheat bran diet and partially hydrolyzed guar gum PHGG. Dig Dis Sci. Poynard T, Regimbeau C, Benhamou Y.
Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. Viera AJ, Hoag S, Shaughnessy J.
Management of irritable bowel syndrome. Am Fam Physician. Bueno L, Fioramonti J, Delvaux M, Frexinos J. Mediators and pharmacology of visceral sensitivity: from basic to clinical investigations. Jackson JL, O'Malley PG, Tomkins G, Balden E, Santoro J, Kroenke K.
Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med. Tabas G, Beaves M, Wang J, Friday P, Mardini H, Arnold G. Paroxetine to treat irritable bowel syndrome not responding to high-fiber diet: a double-blind, placebo-controlled trial.
Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Drossman DA, Toner BB, Whitehead WE, Diamant NE, Dalton CB, Duncan S, et al.
Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Camilleri M, Chey WY, Mayer EA, Northcut AR, Heath A, Dukes GE, et al.
A randomized controlled trial of serotonin type 3 receptor antagonist alosetron in women with diarrhea-predominant irritable bowel syndrome.
Arch Intern Med. Evans BW, Clark WK, Moore DJ, Whorwell PJ. Tegaserod for the treatment of irritable bowel syndrome.
Cochrane Database Syst Rev. Tegaserod maleate Zelnorm for IBS with constipation. Med Lett Drugs Ther. htm zelnorm. Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome.
Camilleri M, Kim DY, McKinzie S, Kim HJ, Thomforde GM, Burton DD, et al. A randomized, controlled exploratory study of clonidine in diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and meta-analysis.
Liu JH, Chen GH, Ye HZ, Huang CK, Poon SK. Entericcoated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial.
Hadley SK, Petry JJ. Medicinal herbs: a primer for primary care. In rarer cases, dehydration and electrolyte disturbances have occurred. These are drugs which slow gut transit. They also decrease intestinal secretion movement of fluid into the intestines and increase the amount of fluid that is reabsorbed by the gastrointestinal GI tract.
In irritable bowel syndrome IBS patients with diarrhea, an antidiarrheal agent such as loperamide is a drug which slows gut transit. Loperamide e. This drug works by bonding to μ-opioid receptors in the GI tract resulting in the changes mentioned above.
Similar to OTC laxatives, a few studies have shown that it solidifies loose stools and reduces the frequency of diarrhea. However, it has not been shown to have a beneficial effect on abdominal pain or discomfort.
These drugs also can improve pain, discomfort, and bloating. Currently there are 3 FDA approved treatments in this class: lubiprostone, linaclotide, plecanatide,. This allows for more water to be retained in the intestines, helping speed up intestinal transit time and results in softer BMs.
Like the secretagogues, it has also been shown to reduce pain and other abdominal symptoms like bloating. Tenapanor Ibsrela® is the first medication in the class of retainagogues. It has also been shown to reduce pain and other abdominal symptoms like bloating. Tenapanor was approved by the FDA for the treatment of IBS-C in adults in The most common side effects noted in clinical trials include diarrhea, abdominal distention, and flatulence.
Tenapanor works in the GI tract and is minimally absorbed. In April , it became commercially available in the United States for the treatment of IBS-C in men and women. Antispasmodics are drugs which suppresses smooth muscle contractions in the GI tract. Anticholinergics reduce spasms or contractions in the intestine.
This provides the potential to reduce abdominal pain and discomfort. The most common anticholinergics include hyoscyamine Levsin®, NuLev®, Levbid® and dicyclomine Bentyl®.
These can be taken daily or as needed. Each dose should be taken minutes prior to a meal. Both drugs can be taken by mouth. Hyoscyamine is also available in a sublingual formulation. The sublingual form is placed under the tongue and allowed to dissolve there.
Limited clinical studies suggest that these may improve pain more specifically cramping in people with IBS. Their efficacy for improving overall IBS symptoms has not yet been proven. As such, this makes them less attractive treatments for IBS. The most common side effects include headaches, dry eyes and mouth, blurred vision, rash as well as mild sedation or drowsiness.
Overall, these side effects are minimal, making them quite safe to use. Smooth muscle relaxants are not currently available for use in the United States. These drugs appear more effective for treating overall IBS symptoms than anticholinergics. The direct smooth muscle relaxants found to be effective include cimetropium, mebeverine, otilonium available in Mexico , pinaverium bromide, and trimebutine.
Side effects with smooth muscle relaxants appear to be rare. Peppermint oil is generally considered an antispasmodic as it shares similar properties with other medications. However, other traits make this particular agent unique.
It causes smooth muscle relaxation by blocking calcium from entering into intestinal smooth muscle cells. Calcium triggers muscle contraction, so the lack of calcium results in relaxing intestinal muscles.
It also has anti-inflammatory, antigas, and anti-serotonergic properties. Serotonin is a chemical found in the gut that accelerates movement. Limiting the amount of serotonin in the gut may be more effective for people with IBS-D.
Recent studies have shown that it can be used to treat both overall symptoms and pain. This treatment may also be used either daily or as needed. Peppermint oil can be found in the form of teas, drops, gels, and capsules. There have not been any specific trials comparing one form to another.
Side effects are uncommon but can include heartburn and nausea. These may be reduced by using a coated form. Coated pills minimize the activity of the peppermint oil in the stomach IBgard®, Pepogest®. Peppermint oil use can rarely cause skin rashes, headaches, or tremors.
In clinical trials, these side effects do not occur more frequently in people taking peppermint oil than in those taking a placebo. A placebo is a pill or treatment with no active ingredients. Antidepressants are neuromodulators that have the ability to impact nerve signaling.
Communication between the GI tract and the brain and spinal cord is specifically affected. This nerve signaling is regulated by chemicals called neurotransmitters. These chemicals are released from nerves and bind to other nerves, muscles, and glands.
The result impacts pain signaling and can potentially increase or decrease GI function. These drugs often affect GI symptoms at lower dosages than used to treat depression or anxiety.
Multiple classes of neuromodulators exist. The ones most commonly used to treat IBS symptoms include the tricyclic antidepressants TCAs and selective serotonin reuptake inhibitors SSRIs.
There is some agreement across international guidelines that TCAs are effective for treating IBS; however, recommendations for using SSRIs remain conflicted.
Antidepressants are considered a global treatment, meaning that it can help multiple IBS symptoms. Be aware that the effectiveness of various agents differs between individuals and a medication regimen must be carefully chosen by the patient and their healthcare provider. Elderly patients may develop confusion or loss of balance, especially at higher doses.
It is common to start with a low daily dose of the drug e. This will help to avoid or reduce many of the more common undesirable side effects. The dose can then be increased based upon how well it works effectiveness and how hard the side effects are to handle tolerance.
Most healthcare providers will not prescribe dosages higher than mg per day. Selective serotonin reuptake inhibitors SSRIs — The most well studied SSRI drugs include citalopram Celexa ® , fluoxetine Prozac ® and Paroxetine Paxil ®. Some healthcare providers also like to use sertraline Zoloft ® given its anti-anxiety properties.
The risk of side effects with these drugs are often milder than the TCAs. Rifaximin Xifaxan ® is the only antibiotic approved by the FDA for treatment of IBS-D.
Its exact mechanism of action is unknown. Brenner, M. Lacy, M. Lacy is a gastroenterologist at Mayo Clinic in Jacksonville, Florida, and a co-author of the American College of Gastroenterology ACG clinical guideline for the management of IBS published in Currently, three categories of antispasmodics are available in North America, each of which has a different mechanism of action:.
Seeking to examine the efficacy and safety of these medications more closely, the co-authors conducted a review of available randomized, placebo-controlled, parallel or crossover studies of antispasmodics currently available in North America United States, Canada and Mexico that involved adults with abdominal pain related to IBS , dyspepsia or FD , and CAPS.
The co-authors' database search identified a total of 26 studies, including 23 focused on IBS , one on FD and two on recurrent abdominal pain with cramping. The search did not identify any studies evaluating antispasmodics in patients with CAPS.
The co-authors then analyzed each study's patient population, treatment regimen, efficacy outcomes and safety outcomes. The co-authors provide detailed information and charts summarizing the available data related to each of the specific medications that are currently available in North America for the treatment of chronic abdominal pain related to DGBI.
After performing this analysis, Drs. Lacy and Brennan concluded that data supporting the use of antispasmodics for the treatment of chronic abdominal pain in patients with DGBI , including IBS and FD , are limited. They note that many of the trials included in this analysis have limited sample size, short duration of therapy, heterogeneity in outcomes and concerns related to study design bias.
This makes it difficult to recommend these agents for clinical use, especially after comparing the data sets available from large, randomized, controlled trials evaluating the performance of IBS medications currently approved for use in the United States," explains Dr.
Researchers at Mayo Clinic in Jacksonville, Florida, are evaluating the use of virtual reality to treat abdominal pain symptoms in patients with functional dyspepsia.
Preliminary results were shared at the meeting of the American College of Gastroenterology in Las Vegas. Brenner DM, et al. Antispasmodics for chronic abdominal pain: Analysis of North American treatment options.
The American Journal of Gastroenterology. Lacy BE, et al. ACG clinical guideline: Management of irritable bowel syndrome. Refer a patient to Mayo Clinic. This content does not have an English version.
Home » Treatment. At first Remediex treatments for IBS aimed Digesgive improving one of these Antispasmodic Remedies for Digestive Disorders symptoms. Dsiorders, our better knowledge of the causes of IBS has allowed us to develop treatments that improve both the abdominal component along with the bowel issues. A laxative is a drug that increases bowel function in patients experiencing constipation. There are many laxatives available without a prescription.Video
Pharmacology - GASTROINTESTINAL AND ANTIEMETIC DRUGS (MADE EASY) Antispasmodics help Antispasmodic Remedies for Digestive Disorders gut spasms Antispasmovic cramps associated Remfdies irritable bowel syndrome. However, they may have potential side Antispasmodic Remedies for Digestive Disorders. You may need to try more than African mango extract benefits to find relief from your IBS symptoms. Irritable bowel syndrome IBS is a digestive disorder that can cause a range of painful and uncomfortable symptoms. Treatment commonly includes antispasmodic medications, which control gut spasms and help ease symptoms such as diarrhea, constipation, and abdominal pain. Learn more about IBS. Antispasmodics are a type of muscle-relaxing medication. Antispasmodic Remedies for Digestive Disorders -
You can also read the patient information leaflet that comes with them. You may be encouraged to take antispasmodics at specific times of day, in relation to when your symptoms occur. It is generally recommended that you only take antispasmodics when necessary, stopping if the symptoms settle down.
Most people who take antispasmodics will not have any serious side effects. Generally smooth muscle relaxant antispasmodics will have fewer, milder side effects than antimuscarinics.
This is because antimuscarinics block the chemical messenger acetylcholine, which has other roles within the body, including dilating blood vessels, increasing bodily secretions and slowing your heart rate.
You can read the accompanying patient information leaflet for medicine-specific side effects and cautions. Most people can take antispasmodics safely, however there are a few exceptions.
This will be listed in the patient information leaflets, and includes:. Why not sign up to our mailing list and receive regular articles and tips about IBD to your inbox.
Why not sign up to our mailing list and receive regular articles and tips about IBD to your inbox? Home Learn Treatment Medication for IBD Antispasmodics and IBD. Related links Medication for IBD Over the counter medication. What are antispasmodics? Why are antispasmodics used in IBD?
Types of antispasmodics When to use antispasmodics for IBD Side effects of antispasmodics. What are antispasmodic medicines? Why might I use antispasmodic medicines in IBD? What types of antispasmodics are there?
Selective serotonin reuptake inhibitors SSRIs are being examined for the treatment of IBS. This benefit also was present in the subset without depression. Given the limited evidence, SSRIs are not recommended as routine or first-line therapy for IBS except in patients who also have comorbid depression.
Although anxiolytics e. Psychotherapies should be considered for motivated patients who have more severe or disabling symptoms. Antagonism of serotonin receptor subtype 5-hydroxy-tryptamine-3 5-HT 3 reduces noxious stimuli perception, increases colonic compliance, and decreases gastrocolonic reflexes.
Alosetron Lotronex , the first IBS-specific medication approved by the U. Food and Drug Administration FDA , is a highly selective central penetrating 5-HT 3 antagonist.
Alosetron did show a clinically significant, although modest, gain over placebo 41 versus 26 percent in alleviating IBS symptoms such as bloating and pain. It became available again in late , but with strict prescribing regulations. Alosetron is indicated only for women with severe diarrhea-predominant symptoms and for whom conventional treatment has failed.
Constipation may result from its use. Stimulation of the serotonin receptor subtype 5-hydroxy-tryptamine-4 5-HT 4 increases colonic transit time and inhibits visceral sensitivity.
Tegaserod Zelnorm , a partial 5-HT 4 receptor agonist, is an aminoguanidine indole similar to serotonin. Tegaserod stimulates the release of neurotransmitters and increases colonic motility; it is more effective than placebo in constipation-predominant IBS.
Tegaserod is approved for up to 12 weeks of use for treatment of constipation-predominant IBS in women. There are a variety of other agents with reported advantages in treating IBS symptoms.
Antibiotics may be recommended for the treatment of refractory diarrhea if bacterial infection is suspected. Antibiotics are not indicated for long-term use because they may increase diarrhea through changes in the bowel flora.
Probiotics consist of a preparation containing a single- or mixed-culture of live microbes that exert beneficial health effects by altering the gastrointestinal flora. Studies with probiotics demonstrate a trend toward improvement of IBS symptoms and are promising enough to warrant further investigation.
The alpha adrenoceptor antagonist clonidine Catapres has been shown in a single small study 26 to provide overall relief at a dosage of 0. Given the absence of a cure and the adverse effects of medications, patients with IBS often turn to complementary therapies.
Peppermint possesses antispasmodic properties and has long been associated with improvement of digestive function. Peppermint leaves contain oils that have mild anesthetic properties, relieve nausea, and relax smooth muscle spasticity caused by histamine and cholinergic stimulation.
The placebo response ranged from 13 to 52 percent with a mean of 31 percent including all five trials. Peppermint is contraindicated in patients with gastroesophageal reflux disease. The herb ginger also may play a role in IBS treatment.
One component, gingerois, functions as a serotonin 5-HT antagonist and enhances motility. None of these agents has been studied in any clinical trials measuring patient-oriented outcomes. Given the variability of IBS, the most successful treatment will be comprehensive, involving multiple strategies Figure 1 1.
Patients should be allowed to participate actively in their care, and therapies should focus on particular types of gastrointestinal dysfunction. Further treatments are based on the type and severity of symptoms. Constipation-predominant IBS with mild symptoms may benefit from additional fluids, guar gum, exercise, and fiber.
For constipation-predominant IBS with moderate symptoms, an antispasmodic, peppermint oil, or osmotic laxative may be appropriate. In severe cases, the aforementioned may be supplemented with tricyclic antidepressants, psychotherapy, and consideration of serotonin 5-HT 4 -agonist.
For diarrhea-predominant IBS, begin with dietary changes and add an antispasmodic, loperamide, or peppermint oil if symptoms are moderate.
In severe diarrhea-predominant IBS, consider tricyclic antidepressants, therapy, and a serotonin 5-HT 3 antagonist. In pain-predominant IBS, use an antispasmodic; a tricyclic antidepressant; and, if severe with diarrhea, consider a serotonin 5-HT 3 agonist.
Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain.
Olden KW. Irritable bowel syndrome: an overview of diagnosis and pharmacologic treatment. Cleve Clin J Med. American College of Gastroenterology Functional Gastrointestinal Disorders Task Force.
Evidence-based position statement on the management of irritable bowel syndrome in North America. Am J Gastroenterol. Talley NJ, Spiller R. Irritable bowel syndrome: a little understood organic bowel disease?. Nanda R, James R, Smith H, Dudley CR, Jewell DP. Food intolerance and the irritable bowel syndrome.
Friedman G. Diet and the irritable bowel syndrome. Gastroenterol Clin North Am. Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, et al. Systematic review on the management of irritable bowel syndrome in North America.
Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med. Parisi GC, Zilli M, Miani MP, Carrara M, Bottona E, Verdianelli G, et al.
High-fiber diet supplementation in patients with irritable bowel syndrome IBS : a multicenter, randomized, open trial comparison between wheat bran diet and partially hydrolyzed guar gum PHGG. Dig Dis Sci. Smooth muscle relaxants are not currently available for use in the United States.
These drugs appear more effective for treating overall IBS symptoms than anticholinergics. The direct smooth muscle relaxants found to be effective include cimetropium, mebeverine, otilonium available in Mexico , pinaverium bromide, and trimebutine.
Side effects with smooth muscle relaxants appear to be rare. Peppermint oil is generally considered an antispasmodic as it shares similar properties with other medications. However, other traits make this particular agent unique. It causes smooth muscle relaxation by blocking calcium from entering into intestinal smooth muscle cells.
Calcium triggers muscle contraction, so the lack of calcium results in relaxing intestinal muscles. It also has anti-inflammatory, antigas, and anti-serotonergic properties.
Serotonin is a chemical found in the gut that accelerates movement. Limiting the amount of serotonin in the gut may be more effective for people with IBS-D. Recent studies have shown that it can be used to treat both overall symptoms and pain. This treatment may also be used either daily or as needed.
Peppermint oil can be found in the form of teas, drops, gels, and capsules. There have not been any specific trials comparing one form to another. Side effects are uncommon but can include heartburn and nausea.
These may be reduced by using a coated form. Coated pills minimize the activity of the peppermint oil in the stomach IBgard®, Pepogest®. Peppermint oil use can rarely cause skin rashes, headaches, or tremors.
In clinical trials, these side effects do not occur more frequently in people taking peppermint oil than in those taking a placebo. A placebo is a pill or treatment with no active ingredients. Antidepressants are neuromodulators that have the ability to impact nerve signaling.
Communication between the GI tract and the brain and spinal cord is specifically affected. This nerve signaling is regulated by chemicals called neurotransmitters. These chemicals are released from nerves and bind to other nerves, muscles, and glands.
The result impacts pain signaling and can potentially increase or decrease GI function. These drugs often affect GI symptoms at lower dosages than used to treat depression or anxiety.
Multiple classes of neuromodulators exist. The ones most commonly used to treat IBS symptoms include the tricyclic antidepressants TCAs and selective serotonin reuptake inhibitors SSRIs. There is some agreement across international guidelines that TCAs are effective for treating IBS; however, recommendations for using SSRIs remain conflicted.
Antidepressants are considered a global treatment, meaning that it can help multiple IBS symptoms. Be aware that the effectiveness of various agents differs between individuals and a medication regimen must be carefully chosen by the patient and their healthcare provider.
Elderly patients may develop confusion or loss of balance, especially at higher doses. It is common to start with a low daily dose of the drug e. This will help to avoid or reduce many of the more common undesirable side effects.
The dose can then be increased based upon how well it works effectiveness and how hard the side effects are to handle tolerance.
Most healthcare providers will not prescribe dosages higher than mg per day. Selective serotonin reuptake inhibitors SSRIs — The most well studied SSRI drugs include citalopram Celexa ® , fluoxetine Prozac ® and Paroxetine Paxil ®. Some healthcare providers also like to use sertraline Zoloft ® given its anti-anxiety properties.
The risk of side effects with these drugs are often milder than the TCAs. Rifaximin Xifaxan ® is the only antibiotic approved by the FDA for treatment of IBS-D. Its exact mechanism of action is unknown. Studies have suggested that it works by modifying bacterial structure or function in the gut potentially targeting the small intestine.
It also appears to have anti-inflammatory properties. Rifaximin improves overall IBS-D symptoms. Rifaximin is a global treatment, meaning that it can help multiple IBS symptoms.
This drug differs from other IBS-D treatments as it is only taken for 2- weeks. If Rifaximin is beneficial, symptom relief should occur following the 2-week treatment. Symptoms may return after the initial treatment, and 2 successive treatments are allowed.
It is minimally absorbed and generally well tolerated. The most commonly experienced adverse event is nausea. Serotonin receptors in the GI tract appear to be a good target for treating IBS symptoms.
Currently two therapies are FDA approved for the treatment of IBS-C and IBS-D. More recent studies have shown that rare cases of serious complications of constipation and ischemic colitis may still occur. Despite this, it appears safe when prescribed within a small therapeutic window 0.
It should not be used as the first treatment choice in a newly diagnosed patient to treat IBS-D. Multiple other agents have been tested in small trials for the treatment of IBS.
Symptoms are often similar between bile acid malabsorption BAM and IBS-D. Cholesterol is changed into bile acids by the liver.
These acids are then absorbed back into the body in the colon. Sometimes, bile acids are not reabsorbed properly, leading to BAM. Too much bile acid in the colon can result in watery stool, urgency and fecal incontinence.
This is why BAM is sometimes called bile acid diarrhea. It has also been evaluated for the treatment of IBS-D. While less studied, it appears to work like alosetron without the increased risk of severe constipation or ischemic colitis.
Pregaballin has been shown to improve pain, bloating and diarrhea symptoms in a small study of IBS patients. These are also being studied for the relief of IBS symptoms. A recent analysis of 3 studies offered conflicting results.
This suggests that the bacteria used, route of administration of the bacteria, and specific IBS subtype may all play a role in symptom response. Fecal transplants are not currently recommended for treating IBS symptoms. Common Therapies with Proven Efficacy for Global IBS Symptoms Based on Use in Most Common IBS Subtype.
By: Darren M. Brenner, MD, Associate Professor of Medicine and Surgery, Northwestern University — Feinberg School of Medicine, Chicago, Illinois; Adapted from an article by: Tony Lembo, MD, Professor, of Medicine and Rebecca Rink MS, Beth Israel Deaconess Medical Center, Harvard Medical School, MA; Edited by: Lin Chang, M.
IFFGD is a nonprofit education and research organization.
Herbal sleep aid can respond Antospasmodic Muscle growth supplements for mass to natural remedies — Antsipasmodic these are all things Muscle growth supplements for mass can fkr easily and affordably from your supermarket, health food Promote digestive wellness or even your own garden. Peppermint, Antispasmodc and fennel all have soothing, antispasmodic properties, and apple cider vinegar appears to ease digestive problems too. Taking probiotics is another simple gut-friendly habit to get into. Make one or two of these natural remedies a part of your daily diet and you should reap the rewards. Well-known for its stomach settling properties, peppermint can be taken as a tea or as a peppermint oil capsule.
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