Correspondence

Red Pepper and Functional Dyspepsia

N Engl J Med 2002; 346:947-948March 21, 2002

Article

To the Editor:

Functional dyspepsia is a common and distressing chronic digestive disorder of unknown cause.1,2 We examined the effect of treatment of functional dyspepsia with capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide), a component of red-pepper (Capsicum annum) powder. Capsaicin selectively impairs the activity of nociceptive C fibers carrying pain sensations to the central nervous system3 and has been shown to relieve pain of cutaneous and mucosal origin.4

After the exclusion of patients with gastroesophageal reflux and irritable bowel syndrome, we monitored 30 patients with functional dyspepsia2 for two weeks while they were receiving no medications. Fifteen patients were randomly assigned in a double-blind manner to receive 2.5 g of red-pepper powder a day (contained in capsules taken before each of three meals) for five weeks, and the other 15 were randomly assigned to receive placebo capsules. The capsaicin content was 0.7 mg per gram of red-pepper powder, as determined by means of high-performance liquid chromatography. A diary sheet was given to each patient to record daily symptom scores. The symptom scores obtained in the red-pepper group during the entire treatment period were compared with those obtained in the placebo group, and the mean weekly scores in both groups were plotted against time and compared between groups and with the corresponding base-line value obtained the week before treatment began. Parametric tests (analysis of variance for repeated measurements and Student's t-test for paired data) and a nonparametric test (the Mann–Whitney U test) were used as appropriate.

Two of the 15 patients in the red-pepper group discontinued the trial because of epigastric pain, and 1 patient in the placebo group stopped treatment for other reasons (P=1.00 by Fisher's exact test). The overall symptom scores as well as the scores for epigastric pain, epigastric fullness, and nausea during the entire treatment period were significantly lower in the red-pepper group than in the placebo group (Figure 1Figure 1Mean (±SD) Scores for Overall and Individual Symptoms during the Entire Treatment Period with Red Pepper or Placebo.). The weekly scores in the red-pepper group were significantly lower than those in the placebo group beginning in the third week of treatment (Table 1Table 1Base-Line and Weekly Scores for Overall and Individual Symptoms in the Red-Pepper Group and the Placebo Group.) and, in the last week of treatment, had decreased by a mean of approximately 60 percent, whereas those in the placebo group had decreased by approximately 30 percent. The administration of red pepper was more effective than placebo in decreasing the intensity of dyspeptic symptoms, probably through a capsaicin-induced desensitization of gastric nociceptive C fibers. Although larger trials with standardized materials are needed, capsaicin could represent a potential therapy for functional dyspepsia.5

Mauro Bortolotti, M.D.
University of Bologna, 40138 Bologna, Italy
bortolottim@orsola-malpighi.med.unibo.it

Gianni Coccia, M.D.
Galliera Hospital, 16136 Genoa, Italy

Gabriele Grossi, M.D.
S. Orsola Policlinic, 40138 Bologna, Italy

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Citing Articles (9)

Citing Articles

1. 1

   M. Bortolotti, S. Porta. (2011) Effect of Red Pepper on Symptoms of Irritable Bowel Syndrome: Preliminary Study. Digestive Diseases and Sciences 56:11, 3288-3295
   CrossRef

2. 2

   O S van Boxel, J J M ter Linde, P D Siersema, A J P M Smout. (2010) Role of Chemical Stimulation of the Duodenum in Dyspeptic Symptom Generation. The American Journal of Gastroenterology 105:4, 803-811
   CrossRef

3. 3

   Richard D. Verschoyle, William P. Steward, Andreas J. Gescher. (2007) Putative Cancer Chemopreventive Agents of Dietary Origin—How Safe Are They?. Nutrition and Cancer 59:2, 152-162
   CrossRef

4. 4

   Francesco Di Mario, Lucas G. Cavallaro, Antonio Nouvenne, Nicoletta Stefani, Giulia M. Cavestro, Veronica Iori, Marta Maino, Giuseppe Comparato, Libera Fanigliulo, Ester Morana, Alberto Pilotto, Laura Martelli, Mario Martelli, Gioacchino Leandro, Angelo Franzè. (2007) A Curcumin-Based 1-Week Triple Therapy for Eradication of Helicobacter pylori Infection: Something to Learn From Failure?. Helicobacter 12:3, 238-243
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   W. Greffrath. (2006) Der Capsaicinrezeptor. Der Schmerz 20:3, 219-225
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   András Dömötör, Zsanett Peidl, Áron Vincze, Béla Hunyady, János Szolcsányi, László Kereskay, György Szekeres, Gyula Mózsik. (2005) Immunohistochemical distribution of vanilloid receptor, calcitonin-gene related peptide and substance P in gastrointestinal mucosa of patients with different gastrointestinal disorders. InflammoPharmacology 13:1-3, 161-177
   CrossRef

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   Maria-Simonetta Faussone-Pellegrini, Antonio Taddei, Elisa Bizzoco, Massimo Lazzeri, Maria Giuliana Vannucchi, Paolo Bechi. (2005) Distribution of the vanilloid (capsaicin) receptor type 1 in the human stomach. Histochemistry and Cell Biology 124:1, 61-68
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   P. Holzer. (2002) Sensory neurone responses to mucosal noxae in the upper gut: relevance to mucosal integrity and gastrointestinal pain. Neurogastroenterology and Motility 14:5, 459-475
   CrossRef

9. 9

      . (2002) Peper en maagpijnjournaalbericht maagklachten maagpijn. Huisarts en Wetenschap 45:6, 467-467
   CrossRef