Melatonin for the treatment of irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is a common disorder characterized by recurrent abdominal pain or discomfort, in combination with disturbed bowel habits in the absence of identifiable organic cause. Melatonin (N-acetyl-5-methoxytryptamine) is a hormone produced by the pineal gland and also large number by enterochromaffin cells of the digestive mucosa. Melatonin plays an important part in gastrointestinal physiology which includes regulation of gastrointestinal motility, local anti-inflammatory reaction as well as moderation of visceral sensation. Melatonin is commonly given orally. It is categorized by the United States Food and Drug Administration as a dietary supplement. Melatonin treatment has an extremely wide margin of safety though it may cause minor adverse effects, such as headache, rash and nightmares. Melatonin was touted as a potential effective candidate for IBS treatment. Putative role of melatonin in IBS treatment include analgesic effects, regulator of gastrointestinal motility and sensation to sleep promoter. Placebo-controlled studies in melatonin suffered from heterogeneity in methodology. Most studies utilized 3 mg at bedtime as the standard dose of trial. However, all studies had consistently showed improvement in abdominal pain, some showed improvement in quality of life of IBS patients. Melatonin is a relatively safe drug that possesses potential in treating IBS. Future studies should focus on melatonin effect on gut mobility as well as its central nervous system effect to elucidate its role in IBS patients.

Keywords: Melatonin; Irritable bowel syndrome; Pain; Sleep; Analgesia

Core tip: Irritable bowel syndrome (IBS) is a common disorder associated with significant disability and high social cost. This is partly due to lack of effective treatment with low side effects. Melatonin is a drug that was postulated to be a potential useful arsenal in battling IBS. Its role in analgesia has been recognized in several other fields of medicine. Several well-designed placebo-controlled trials in IBS patients had consistently showed improvement of abdominal pain when taking 3 mg of melatonin with no serious side effect. Future studies should examine the long term effect of Melatonin as well as its effect on central nervous system and gut motility.