Curcumin is an active ingredient in the culinary spice turmeric (Curcuma longa). This compound exhibits a broad range of biological properties, such as anti-inflammatory, antioxidant, antiproliferative and antimicrobial properties. According to new research, curcumin and omeprazole have comparable efficacy for functional dyspepsia with no obvious synergistic effect.
Patients with functional dyspepsia treated with curcumin, curcumin plus omeprazole and omeprazole had similar significant symptomatic improvement. Image credit: Andrea Ajale.
Functional dyspepsia is a frequently occurring disorder that can be caused by a variety of factors, with no evidence of other structural diseases that exhibit similar symptoms.
Although dyspepsia is common, many patients do not schedule an appointment with a doctor to treat this condition.
A quarter of patients with dyspepsia have symptoms that require specific treatment, while the rest do not have symptoms that define them as functional dyspepsia.
In a primary care setting, the initial approach for managing functional dyspepsia typically involves a combination of behavioral and dietary modifications, as well as over-the-counter medications.
Behavioral and dietary modifications aim to address triggers and lifestyle factors that may contribute to the symptoms.
Over-the-counter proton pump inhibitors (PPIs) such as omeprazole are commonly recommended in several countries as a first line medication, but patients with persistent symptoms may require further medical attention to explore the possibility of Helicobacter pylori infection.
Turmeric has a long history of extensive use. This plant has a valuable active compound, curcumin, which is used both topically and orally for medicinal purposes.
While curcumin is commonly found in nourishing creams and cosmetics, it is also available in the form of powder capsules used for treating various gastrointestinal problems, including dyspepsia.
Recent studies suggested that curcumin may offer moderate improvement in dyspepsia symptoms compared with placebo. However, there is currently a lack of head-to-head evidence comparing the efficacy of curcumin with conventional drugs.
Among the Thai population and individuals residing near Thailand, turmeric is frequently used to alleviate dyspepsia-like symptoms. However, conventional physicians have been hesitant to consider this herbal medicine as the primary treatment for functional dyspepsia, mainly due to a lack of research comparing the effectiveness and side effects of curcumin with PPIs.
“We aimed to compare the efficacy of curcumin with a PPI in the treatment of patients with functional dyspepsia,” said Dr. Krit Pongpirul from the Chulalongkorn University Faculty of Medicine and colleagues.
In the study, the researchers randomly assigned 206 patients aged 18-70 with functional dyspepsia recruited from hospitals in Thailand between 2019 and 2021, to one of three treatment groups for a period of 28 days.
These were: turmeric (two large 250 mg capsules of curcumin 4 times a day) and one small dummy capsule (69 patients); omeprazole (one small 20 mg capsule daily and two large dummy capsules 4 times a day (68 patients); and turmeric plus omeprazole (69 patients).
Of the 206 patients enrolled, 151 completed the study, with 20 in the curcumin group; 19 in the omeprazole group; and 16 in the combined treatment group, dropping out.
Patients in all three groups had similar clinical characteristics and indigestion scores, as assessed by the Severity of Dyspepsia Assessment score (SODA) at the start of the trial.
Patients were reassessed after 28 days and then again after 56 days.
SODA scores indicated significant reductions in symptom severity by day 28 for pain (-4.83, -5.46 and -6.22) and other symptoms (-2.22, -2.32, and -2.31) for those in the combined, curcumin alone, and omeprazole alone groups, respectively.
These improvements were even stronger after 56 days for pain (-7.19, -8.07 and -8.85, respectively) and other symptoms (-4.09, -4.12 and -3.71, respectively).
SODA also captures satisfaction scores: these scarcely changed over time among the curcumin users, which might possibly be related to its taste and/or smell.
“No serious side effects were reported, although liver function tests indicated some level of deterioration among curcumin users carrying excess weight,” the authors said.
“This multicentre randomised controlled trial provides highly reliable evidence for the treatment of functional dyspepsia.”
“The findings from our study may justify considering curcumin in clinical practice.”
The study was publsihed in the journal BMJ Evidence-Based Medicine.
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P. Kongkam et al. Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial. BMJ Evidence-Based Medicine, published online September 11, 2023; doi: 10.1136/bmjebm-2022-112231
