DISCUSSIONThe Gastroenterological A

DISCUSSION
The Gastroenterological Association of Thailand reported that the prevalence of dyspepsia in Thais was 20% to 25% and the incidence of dyspepsia in Thais was 1% to 2%. A significant proportion of dyspeptic patients were functional dyspepsia cases. Therefore functional dyspepsia is one of the very common health problems in Thailand and it consumes a large amount of health care resources. A meta-analysis on psychological interventions for non-ulcer dyspepsia concluded that there was insufficient evidence to confirm the efficacy of psychological intervention in non-ulcer dyspepsia.4 Another meta-analysis on pharmacological interventions for non-ulcer dyspepsia revealed that prokinetics, H2 receptor antagonists and proton pump inhibitors were effective in therapy of non-ulcer dyspepsia.5 These effective medications are expensive and have side effects. Many herbal medicines were found to be effective for treatment of functional dyspepsia. They were ganaton, extracts from bitter candy tuft, matricaria flower, peppermint leaves, caraway, licorice root & lemon balm, artichoke leaf extract, iberogast, peppermint oil & caraway oil and red pepper.6-12 However there has been no study on the efficacy and safety of cinnamon stomachic mixture for treatment of functional dyspepsia.

We conducted this randomized controlled study in 6 community hospitals where sophisticated investigations such as gastroscopic examination and urea breath test were unavailable and we needed to enroll the subjects diagnosed as having functional dyspepsia based on their clinical features. Simethicone was chosen as a comparator drug instead of placebo because there was evidence that simethicone was more effective than a placebo in treating functional dyspepsia.2,3 Simethicone was also the medication most commonly used by health care personnel at these community hospitals for treating the patients with functional dyspepsia. We did not use cisapride in our study although it was a prokinetic drug because cisapride has many drug interactions leading to serious side effects and it is no longer a treatment option in functional dyspepsia.13,14

Our study found that cinnamon stomachic mixture was effective in alleviating the symptoms by 70% and had a favorable response of 63% at the end of 2 weeks, similar to that of simethicone. The use of cinnamon stomachic mixture for longer duration might increase the response rate since many clinical studies on the treatment of functional dyspepsia used the study medications for longer than 4 weeks 2,3,9,12,15-17 and they found a favorable response of up to 80%. However, we did not use a longer duration of treatment since we thought that the patients who did not respond to a 2-week course of medication should have further appropriate investigations performed to detect organic causes of their persistent dyspeptic symptoms. The side effects of cinnamon stomachic mixture were uncommon and all of them had mild severity. The patients who received cinnamon stomachic mixture showed a very good compliance to treatment and were satisfied with this treatment. Moreover the cost of a 14-day course of cinnamon stomachic mixture was 36 baht compared with 84 baht for that of simethicone.

In summary cinnamon stomachic mixture for 2 weeks is effective, safe and cheap in relieving the symptoms of 60% of the patients with a clinical diagnosis of functional dyspepsia and it should be included as a treatment option for functional dyspepsia, especially in community hospitals.