Evidence review
Peppermint for IBS
Mentha × piperita
The short answer
Good clinical evidenceProbably, for many adults, though the benefit is modest. Meta-analyses find that enteric-coated peppermint oil capsules ease overall IBS symptoms and belly pain more than placebo, roughly one extra person helped for every four treated, and US and UK gastroenterology guidelines suggest them. The evidence is rated low quality, the two most rigorous recent adult trials missed their main goals, and heartburn is a common side effect.
7 key studies reviewed
Updated October 12, 2026
Key points
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01
Better than placebo, modestly
In a 2022 meta-analysis of 10 trials (1,030 people), about one extra person improved for every four treated for overall symptoms, and one for every seven for belly pain.
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02
Rigorous recent trials were mixed
A 190-person Dutch trial and an NIH-funded US trial both missed their primary goals, and a 2026 trial in 228 children found no benefit over placebo.
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03
Guidelines suggest it cautiously
The ACG suggests peppermint oil for overall IBS symptoms on low-quality evidence; the BSG gives a weak recommendation on very low-quality evidence.
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04
The capsule matters, not tea
Trials tested enteric-coated capsules of about 180–190 mg of oil, usually three times a day. We found no trial of peppermint tea for IBS.
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05
Heartburn and coating cautions
Swallow capsules whole 30 minutes before meals, apart from antacids and acid reducers. Avoid them with gallstones, liver disease, or no stomach acid.
Peppermint oil probably helps IBS for many adults, but the benefit is modest and the evidence less solid than its popularity suggests. Several meta-analyses (studies that pool the results of several trials) have found that enteric-coated peppermint oil capsules, which are coated to pass through the stomach before releasing the oil, ease overall IBS symptoms and abdominal pain more than a placebo (dummy capsule); a 2022 update by Ingrosso and colleagues estimated that about one extra person improves for every four treated. The American College of Gastroenterology (ACG) and the British Society of Gastroenterology (BSG) both suggest peppermint oil, and the European Medicines Agency (EMA) accepts the capsules as a well-established medicine for cramping, wind, and abdominal pain, especially in IBS. The caveats are real: most trials were small and short, the evidence is rated low or very low quality, the two most carefully designed recent adult trials missed their primary goals, a large 2026 trial in children found no benefit, and heartburn is a common side effect.
Irritable bowel syndrome (IBS) is a common long-term condition, now described as a disorder of gut–brain interaction, in which recurring belly pain goes with changes in bowel habit: diarrhea, constipation, or both, often with bloating. Peppermint (Mentha × piperita) is a natural hybrid of water mint and spearmint, and peppermint oil is the essential oil distilled from its leaves and flowering tops, whose main component is menthol. In the gut, peppermint oil relaxes the smooth muscle of the bowel wall, an effect usually credited to menthol blocking calcium channels, and the ACG notes that it may also dampen gut pain signals through TRP (transient receptor potential) channels on nerves. That is why the BSG groups it with antispasmodics, medicines that relax the bowel, such as hyoscine (Buscopan). People search for peppermint oil capsules, peppermint tea, and peppermint sweets, but only coated capsules have meaningful trial evidence.
This page goes through the meta-analyses and the individual trials, including the null ones and who paid for them; what guidelines and regulators say; which products and doses were tested and why the coating matters; how peppermint tea differs; and who should avoid peppermint oil, including people with reflux, gallbladder or liver disease, children, and people taking acid-reducing medicines. Nothing here is medical advice. IBS should be diagnosed by a clinician before you treat it yourself, because celiac disease, inflammatory bowel disease (IBD), and, less often, bowel cancer can cause similar symptoms, and a few simple tests and questions about warning signs help tell them apart.
02 The trials
Key studies
The trials and reviews that carry the most weight for this question, with the product and dose each one tested. Results apply to the preparation studied.
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Ingrosso et al., 2022
Systematic review and meta-analysis of 10 randomized placebo-controlled trials
- Who
- 1,030 people with IBS
- What and how much
- Peppermint oil capsules in various formulations
- How long
- Literature searched to April 2022
Fewer people failed to improve on peppermint oil for global symptoms (relative risk 0.65; number needed to treat 4, 95% CI 2.5 to 71) and for abdominal pain (0.76; NNT 7). Adverse events were more common (RR 1.57), and evidence quality was very low.
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Meyer et al., 2026
Systematic review and meta-analysis of plant-based IBS treatments; 7 peppermint oil trials pooled
- Who
- 668 people with IBS in the peppermint oil analysis
- What and how much
- Peppermint oil capsules from seven trials, including Colpermin, Mintoil, IBgard, and Tempocol
- How long
- Literature searched to May 2024
46% on peppermint oil (144 of 311) versus 27% on placebo (97 of 357) reported benefit (RR 1.63, 1.33 to 2.00; NNT about 6), with no measurable disagreement between trials (I² 0%). Authors declared no conflicts.
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Alammar et al., 2019
Systematic review and meta-analysis of 12 randomized trials
- Who
- 835 adults with IBS
- What and how much
- Peppermint oil capsules in various formulations
- How long
- Trials of 2 to 12 weeks
Global symptoms improved more often with peppermint oil (RR 2.39 from 7 trials) and so did abdominal pain (RR 1.78 from 6 trials); NNT 3 and 4. Adverse events 9.3% versus 6.1%, not a significant difference.
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Weerts et al., 2020 (PERSUADE)
Randomized, double-blind, placebo-controlled, 4 Dutch hospitals; publicly funded (ZonMw)
- Who
- 190 adults with Rome IV IBS (189 analyzed)
- What and how much
- Tempocol small-intestinal-release or a new ileocolonic-release capsule, 182 mg peppermint oil three times daily
- How long
- 8 weeks
Missed the primary pain-response goal: 46.8% (small-intestinal) and 41.3% (ileocolonic) versus 34.4% on placebo, not significant. Small-intestinal release improved pain, discomfort, and IBS severity as secondary outcomes; mild side effects were more common.
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Vermeijden et al., 2026
Randomized trial in 13 Dutch hospitals; capsules double-blind, sweets open-label; hospital-sponsored
- Who
- 228 children aged 8 to 18 with IBS or functional abdominal pain
- What and how much
- Tempocol 182 mg capsules, peppermint sweets (9.2 mg oil), or placebo, two or three times daily
- How long
- 8 weeks plus 4 weeks follow-up
Pain fell by at least 30% in 44.0% on peppermint oil versus 37.3% on placebo (P = .44), and peppermint sweets did no better than placebo; adverse events were mild and infrequent.
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Nee et al., 2021
Randomized, double-blind, placebo-controlled, single US center; NIH (NCCIH) funded
- Who
- Adults with moderate to severe Rome IV IBS, randomized 1:2 to peppermint oil or placebo
- What and how much
- Enteric-coated peppermint oil, 180 mg three times daily
- How long
- 6 weeks
Symptom scores (IBS-SSS) fell by 90.8 points with peppermint oil and 100.3 with placebo, no significant difference (P = 0.97); no secondary outcome differed.
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Cash et al., 2016
Randomized, double-blind, placebo-controlled; manufacturer-funded
- Who
- 72 adults with IBS with diarrhea or mixed IBS (Rome III)
- What and how much
- IBgard, triple-coated microspheres of peppermint oil, 180 mg three times daily
- How long
- 4 weeks
Total IBS symptom score fell 40% versus 24.3% on placebo (P = 0.0246), with a difference already at 24 hours. Funded by IM HealthScience; all three authors held company roles.
03 Evidence
What the research shows
Our rating for Peppermint for IBS, based on the studies below.
Meta-analyses have consistently favored peppermint oil. Ford and colleagues (BMJ 2008) pooled four placebo-controlled trials with 392 patients and found a relative risk of symptoms persisting of 0.43, meaning persistent symptoms were less than half as likely as on placebo. Khanna and colleagues (Journal of Clinical Gastroenterology 2014) analyzed nine trials with 726 patients: global symptoms improved more often with peppermint oil (relative risk 2.23, five trials) and so did abdominal pain (2.14, five trials), and heartburn was the most common side effect. Alammar and colleagues at Johns Hopkins (BMC Complementary and Alternative Medicine 2019) pooled 12 trials with 835 patients and reported a risk ratio of 2.39 for global improvement and 1.78 for abdominal pain, with three patients needing treatment for one to avoid persistent global symptoms (the number needed to treat, or NNT) and four for pain. Ingrosso, Ford, and colleagues (Alimentary Pharmacology and Therapeutics 2022) updated their earlier work with 10 trials and 1,030 patients and again found peppermint oil better than placebo for global symptoms (NNT 4) and abdominal pain (NNT 7), but the confidence interval for the global NNT ran from 2.5 to 71, adverse events were more frequent with peppermint oil, and they rated the evidence very low quality. The newest pooled analysis, by Meyer and colleagues (Phytotherapy Research 2026), combined seven trials with 668 patients: 46% improved on peppermint oil versus 27% on placebo (risk ratio 1.63; NNT about 6).
The trials behind those numbers were mostly small and short. The ACG guideline notes that the 12 trials in the Alammar review enrolled 18 to 178 patients each, lasted 2 to 12 weeks, came from Asia, Europe, and North America, and could not show which IBS subtype benefits most. Merat and colleagues (Digestive Diseases and Sciences 2010) gave 90 outpatients one Colpermin capsule (an enteric-coated, delayed-release product) or placebo three times a day for eight weeks; by week 8, 14 people on peppermint oil and 6 on placebo were free of abdominal pain or discomfort (P < 0.001). Cappello and colleagues (Digestive and Liver Disease 2007) first excluded small-bowel bacterial overgrowth, lactose intolerance, and celiac disease, then gave 57 patients two enteric-coated Mintoil capsules or placebo twice a day for four weeks; 75% versus 38% had their total symptom score cut by more than half. In the US, Cash and colleagues (Digestive Diseases and Sciences 2016) tested IBgard, peppermint oil in triple-coated microspheres designed to release steadily in the small intestine, at 180 mg three times a day in 72 people with diarrhea-predominant or mixed IBS. After four weeks the total symptom score had fallen 40% versus 24.3% on placebo, and the gap was already significant after 24 hours. That trial was funded by IM HealthScience, the product’s maker; one author was its chief innovation officer, another its chief medical advisor, and the third a consultant to it.
The two most rigorous recent adult trials did not meet their primary goals. In PERSUADE, Weerts and colleagues (Gastroenterology 2020), at four Dutch hospitals and funded by the Netherlands Organisation for Health Research and Development (ZonMw), randomized 190 people with IBS by the strict Rome IV criteria, more than half recruited from primary care, to 182 mg of small-intestinal-release peppermint oil (Tempocol), 182 mg of a new ileocolonic-release version, or placebo three times a day for eight weeks. On the US Food and Drug Administration’s pain-response measure, 46.8% and 41.3% responded versus 34.4% on placebo, and neither difference was significant; overall relief, EMA’s measure, did not differ either. The small-intestinal capsule did reduce abdominal pain, discomfort, and IBS severity on secondary measures, while the colon-targeted version showed no promise, which suggests that where the oil is released matters. Mild side effects were more common with both active capsules. Nee and colleagues (American Journal of Gastroenterology 2021), in a single-center US trial funded by the National Center for Complementary and Integrative Health (NCCIH), randomized adults with moderate to severe Rome IV IBS to 180 mg of enteric-coated peppermint oil three times a day or placebo, in a 1:2 ratio, for six weeks. Symptom scores fell substantially in both groups, by 90.8 points with peppermint oil and 100.3 with placebo, with no significant difference on any outcome; a companion analysis of the same trial counted 30 people on peppermint oil and 71 on double-blind placebo. As summarized by Meyer and colleagues, side effects such as heartburn affected 48% versus 31% in that trial. In both trials the placebo groups improved substantially, which makes a modest benefit hard to confirm.
Evidence in children is weaker and now leans negative. In a two-week trial by Kline and colleagues (Journal of Pediatrics 2001), 42 children aged 8 to 17 with IBS took 187 mg enteric-coated capsules (one or two, three times a day, by weight) or placebo; according to EMA’s assessment report, 75% of those on peppermint oil had less severe pain, but other symptoms did not improve, and no adverse events were reported. The much larger trial by Vermeijden and colleagues (Clinical Gastroenterology and Hepatology 2026), sponsored by St. Antonius Hospital in the Netherlands, randomized 228 children aged 8 to 18 with IBS or functional abdominal pain to 182 mg Tempocol capsules, peppermint sweets containing 9.2 mg of oil, or placebo for eight weeks. Pain fell by at least 30% in 44.0% on peppermint oil and 37.3% on placebo (P = .44), adequate relief was similar (53.3% versus 49.3%), and the sweets did no better than placebo. The authors concluded that treatments aimed at the gut–brain axis should take priority in children.
Guidelines endorse peppermint oil, but cautiously. The ACG’s 2021 guideline (Lacy and colleagues) suggests peppermint to relieve global IBS symptoms as a conditional recommendation based on low-quality evidence, notes that enteric-coated formulations may help with heartburn, and warns that only a small number of commercially available peppermint oil supplements have been rigorously tested. The same guideline recommends against the antispasmodic drugs currently available in the United States for global IBS symptoms, which leaves peppermint oil as the muscle-relaxing option it supports. The BSG’s 2021 guideline (Vasant and colleagues) says peppermint oil may be effective for global symptoms and abdominal pain, a weak recommendation on very low-quality evidence; its updated meta-analysis of eight trials (823 patients) found a relative risk of 0.58, it stresses that results for specific formulations cannot be extrapolated to others, and its network meta-analysis ranked peppermint oil first for global symptoms among unlicensed or traditional treatments. EMA’s assessment report cites the ACG’s 2014 monograph (Ford and colleagues) as rating the evidence moderate quality for specific formulations that may not be universally available. England’s NICE guideline on IBS (CG61) advises considering antispasmodics, taken as needed alongside diet and lifestyle advice, but does not name peppermint oil in its recommendations. EMA’s herbal committee accepts gastro-resistant peppermint oil as well-established use, and NCCIH says enteric-coated peppermint oil may improve IBS symptoms in adults. Open questions remain: which IBS subtype benefits, whether taking it only when needed works (no trial has tested this, the ACG notes), how it compares with prescription antispasmodics, and whether benefits last beyond three months.
04 In practice
How it was taken in studies
Trials tested enteric-coated or similar delayed-release capsules, each holding about 0.2 ml of oil, which EMA’s assessment report equates to roughly 182 to 187 mg. Typical regimens were one capsule three times a day (Colpermin, Tempocol), 180 mg three times a day (IBgard), or two capsules twice a day (Mintoil). EMA’s monograph, for adults and adolescents, gives 0.2 to 0.4 ml per dose and 0.6 to 1.2 ml a day divided into two or three doses, and for children aged 8 to 11, 0.2 ml three times a day; it does not recommend use under 8. Capsules must be swallowed whole, not broken or chewed, 30 minutes before meals, because food or antacids taken at the same time can release the oil too early. The coating is the point of the product: EMA’s assessors explain that heartburn largely comes from oil released in the upper gut, where menthol relaxes the lower esophageal sphincter (the valve between the esophagus and stomach). Products vary in coating, release site, and oil quality, and the BSG cautions that results for one formulation cannot be assumed for another, so choose a single-ingredient, enteric-coated peppermint oil capsule that states its dose.
EMA advises taking the capsules until symptoms resolve, usually within one or two weeks, and for more persistent symptoms continuing for no longer than three months per course. The trials ran 2 to 12 weeks, so four weeks with a simple symptom diary is a reasonable trial; in the IBgard study, differences appeared within 24 hours, while most trials measured results at four to eight weeks. NICE describes antispasmodics as medicines taken as required, but no peppermint oil trial has tested as-needed use. EMA advises against using other peppermint oil products at the same time and recommends seeing a doctor or pharmacist if symptoms worsen. If there is no clear benefit after a month, other options include soluble fiber such as psyllium, a limited trial of a low-FODMAP diet, gut-directed psychological therapies, and prescription medicines matched to the main symptom, all recommended or suggested in the ACG guideline.
Peppermint tea is not the trial product. EMA accepts peppermint leaf tea, 1.5 to 3 g of dried leaf in 100 to 150 ml of boiling water three times a day for adults, only as a traditional remedy for indigestion and wind, based on long use, and it advises people with reflux to avoid peppermint leaf preparations because heartburn may increase. A tea is a different exposure from a measured capsule of concentrated oil, and PubMed searches for this page in October 2026 found no controlled trial of peppermint tea for IBS. In the 2026 Dutch trial in children, peppermint sweets with 9.2 mg of oil did no better than placebo. Tea is a pleasant drink that some people find soothing, but it should not be expected to work like the capsules. Combination capsules of peppermint and caraway oil are a different product, studied mainly for indigestion.
05 Caution
Before you try peppermint
Side effects are usually mild but common. Heartburn was the most common adverse event in Khanna’s meta-analysis, and EMA lists heartburn, burning around the anus, blurred vision, dry mouth, nausea, and vomiting as frequent in clinical trials. The meta-analyses disagree on how much more common side effects are than with placebo: Alammar and colleagues found 9.3% versus 6.1%, not a significant difference, while Ingrosso and colleagues found adverse events significantly more frequent (relative risk 1.57), and in PERSUADE mild adverse events were more common with both peppermint capsules. EMA also lists a menthol smell to urine and stools, painful urination, and inflammation of the tip of the penis, and rare allergic reactions to menthol, including headache, slow heart rate, tremor, unsteadiness, rash, and anaphylactic shock. NCCIH says peppermint oil appears safe by mouth in commonly used doses. Overdose of oral peppermint oil can cause severe gut symptoms, rectal ulceration, seizures, loss of consciousness, and heart rhythm disturbances, so never swallow undiluted essential oil, and keep capsules and oils away from children.
EMA contraindicates the capsules in people allergic to peppermint oil or menthol and in people with liver disease, cholangitis (inflamed bile ducts), achlorhydria (a stomach that makes no acid), gallstones, or any other biliary disorder. People who already have heartburn or a hiatal hernia sometimes find it worse, and EMA advises stopping if so; it also advises caution with inflamed or ulcerated conditions of the gut. Capsules are not recommended under 8, and peppermint oil or menthol products must never be applied to or near the face of a baby or young child: EMA contraindicates its traditional peppermint oil products under 2 years because menthol can cause reflex apnea (breathing stopping) and laryngospasm, and NCCIH gives the same warning. In pregnancy and breastfeeding, EMA does not recommend medicinal peppermint oil because safety has not been established, and it is unknown whether its constituents pass into breast milk; NCCIH says food amounts are likely safe but little is known about medicinal amounts. Tell your midwife or doctor about IBS symptoms in pregnancy rather than self-treating.
Acid-reducing medicines are the most practical interaction. EMA warns that antacids taken at the same time can release the oil early, and that H2 blockers such as famotidine and proton pump inhibitors (PPIs) such as omeprazole may dissolve the coating prematurely and should be avoided with the capsules; early release means more heartburn and less oil reaching the bowel. If you rely on an acid reducer, ask a pharmacist before starting peppermint oil, and never stop a prescribed medicine to make room for a herb. Peppermint oil may also affect drug metabolism: EMA notes some inhibition of CYP3A4, an enzyme in the liver and gut that clears many medicines, in one clinical study with peppermint oil and one with menthol. In a study by Dresser and colleagues (Clinical Pharmacology and Therapeutics 2002), 600 mg of peppermint oil raised overall exposure to the blood pressure drug felodipine to 140% of that with water in 12 volunteers, and in rats peppermint oil tripled peak levels of the transplant drug cyclosporine (Wacher and colleagues, Journal of Pharmaceutical Sciences 2002). Anyone taking cyclosporine or another drug with a narrow safety margin cleared by CYP3A4 should check with their prescriber first.
Some bowel symptoms need a doctor rather than a herb. Get checked promptly for bleeding from the rectum or black, tarry stools, unexplained weight loss, anemia, symptoms that start later in life, symptoms that wake you at night such as nighttime diarrhea, or a family history of bowel cancer, inflammatory bowel disease, or celiac disease. The ACG lists older age at onset, rectal bleeding, weight loss, and family history among its alarm features, and the BSG guideline refers people aged 50 or over with unexplained rectal bleeding, or aged 40 or over with unexplained weight loss and abdominal pain, for suspected bowel cancer. In women, the BSG advises that persistent bloating or swelling of the abdomen should prompt tests for ovarian cancer. NICE recommends a blood count, inflammation markers, and a celiac antibody test before diagnosing IBS. Peppermint oil eases symptoms; it does not rule out another cause, so new or changing symptoms deserve assessment even if the capsules seem to help.
06 Questions
Frequently Asked Questions
For many adults it probably helps a little. Meta-analyses of placebo-controlled trials found that enteric-coated peppermint oil capsules ease overall IBS symptoms and belly pain, with about one extra person helped for every four treated, and the American College of Gastroenterology suggests it. The evidence is rated low quality, two careful recent adult trials missed their main goals, and a large 2026 trial in children found no benefit. Heartburn is the most common side effect. Get IBS diagnosed by a doctor first.
Nobody knows, because no controlled trial has tested peppermint tea for IBS. The trials used enteric-coated capsules holding a measured dose of about 180 mg of concentrated oil. Europe’s herbal committee accepts peppermint leaf tea only as a traditional remedy for indigestion and wind, and advises people with reflux to avoid it because heartburn may increase. Tea is a pleasant, low-risk drink for most adults, and chamomile is another soothing option, but neither should be expected to work like the capsules.
Trials used enteric-coated capsules of about 0.2 ml (roughly 180 mg) of oil, usually one capsule three times a day. Europe’s herbal committee gives adults 0.2 to 0.4 ml per dose, up to 1.2 ml a day in two or three doses. Swallow capsules whole, 30 minutes before meals, and do not chew or open them, which releases the oil too early and can irritate the mouth and esophagus. Avoid taking them with food, antacids, or acid-reducing medicines, and do not combine them with other peppermint oil products.
In one manufacturer-funded trial, symptom scores already differed from placebo after 24 hours, but most trials measured results after four to eight weeks. Europe’s herbal committee advises taking the capsules until symptoms settle, usually within one or two weeks, and for persistent symptoms continuing for no more than three months per course. Keep a simple symptom diary, and if there is no clear benefit after about a month, talk to your doctor about options such as psyllium or a low-FODMAP diet.
It is best not to take them together. Europe’s herbal committee warns that antacids taken at the same time can release the oil early, and that H2 blockers and proton pump inhibitors such as omeprazole may dissolve the enteric coating prematurely, so it advises avoiding the combination. Early release means more heartburn and less oil reaching the bowel. If you need an acid reducer, ask a pharmacist about timing or alternatives, and never stop a prescribed medicine without talking to your prescriber. People with frequent reflux may do better with psyllium.
Capsules are not recommended under 8, and Europe’s herbal committee gives children aged 8 to 11 a lower dose of 0.2 ml three times a day. A small 2001 trial of 42 children found less severe pain after two weeks, but a 2026 trial of 228 children aged 8 to 18 found peppermint oil capsules and peppermint sweets no better than placebo. Never put peppermint oil or menthol near a baby’s or young child’s face, because it can stop their breathing. Ongoing tummy pain in a child needs a pediatric assessment.
07 References
Sources
These references support the claims on this page. They are not an endorsement of any product. The peppermint monograph carries its own full source list.
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ACG Clinical Guideline: Management of Irritable Bowel Syndrome
American Journal of Gastroenterology (PubMed 33315591), 2021
Lacy et al. (full text): suggests peppermint for global IBS symptoms (conditional, low quality); trials of 18–178 patients over 2–12 weeks; PERSUADE missed its primary end point; heartburn; enteric coating may help; few commercial products rigorously tested; no as-needed trials; alarm features.
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British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
Gut (PubMed 33903147), 2021
Vasant et al.: peppermint oil may help global symptoms and abdominal pain (weak recommendation, very low quality); 8 RCTs, 823 patients, RR 0.58; results not transferable between formulations; ranked first for global symptoms in a network meta-analysis; reflux; referral criteria.
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Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome
Alimentary Pharmacology and Therapeutics (PubMed 35942669), 2022
Ingrosso et al.: 10 RCTs, 1,030 patients; RR of global symptoms not improving 0.65 (NNT 4, 95% CI 2.5–71); abdominal pain RR 0.76 (NNT 7); adverse events RR 1.57; very low quality evidence.
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Systematic Review and Meta-Analysis: Plant-Based Therapy for Irritable Bowel Syndrome
Phytotherapy Research (PubMed 42572206), 2026
Meyer et al. (full text): 7 peppermint oil trials, 668 patients; 144/311 versus 97/357 improved; RR 1.63 (1.33–2.00); NNT 5.84; I² 0%; heartburn-type reactions 48% versus 31% in the Nee trial; no conflicts declared.
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The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data
BMC Complementary and Alternative Medicine (PubMed 30654773), 2019
Alammar et al.: 12 RCTs, 835 patients; global improvement RR 2.39 (7 RCTs); abdominal pain RR 1.78 (6 RCTs); NNT 3 and 4; adverse events 9.3% versus 6.1% (RR 1.40, not significant).
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Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis
Journal of Clinical Gastroenterology (PubMed 24100754), 2014
Khanna, MacDonald, and Levesque: 9 RCTs, 726 patients; global improvement RR 2.23 and abdominal pain RR 2.14; adverse events more likely but mild and transient; heartburn most common.
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Efficacy and Safety of Peppermint Oil in a Randomized, Double-Blind Trial of Patients With Irritable Bowel Syndrome
Gastroenterology (PubMed 31470006), 2020
Weerts et al. (PERSUADE): 190 Rome IV patients; 182 mg small-intestinal (Tempocol) or ileocolonic release three times daily for 8 weeks; pain response 46.8% and 41.3% versus 34.4%, not significant; secondary benefits with small-intestinal release; ZonMw-funded (NCT02716285).
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Peppermint Oil Treatment for Irritable Bowel Syndrome: A Randomized Placebo-Controlled Trial
American Journal of Gastroenterology (PubMed 34319275), 2021
Nee et al.: 6-week single-center trial, enteric-coated peppermint oil 180 mg three times daily versus placebo (1:2); IBS-SSS fell 90.8 versus 100.3 points (P = 0.97); NCCIH grant R01 AT008573.
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A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms
Digestive Diseases and Sciences (PubMed 26319955), 2016
Cash, Epstein, and Shah (full text): 72 IBS-D or IBS-M patients; IBgard 180 mg three times daily for 4 weeks; total symptom score −40% versus −24.3% (P = 0.0246); funded by IM HealthScience, with all three authors holding company roles.
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Peppermint Oil and Sweets in Pediatric Irritable Bowel Syndrome and Functional Abdominal Pain: A Randomized Trial
Clinical Gastroenterology and Hepatology (PubMed 41610933), 2026
Vermeijden et al.: 228 children aged 8–18; Tempocol 182 mg, peppermint sweets, or placebo for 8 weeks; treatment success 44.0% versus 37.3% (P = .44); sweets no better than placebo; sponsored by St. Antonius Hospital (NCT05799053).
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European Union herbal monograph on Mentha x piperita L., aetheroleum (Revision 1)
European Medicines Agency (EMA/HMPC/522410/2013), 2020
Well-established use of gastro-resistant oil for spasm, wind, and pain, especially in IBS; 0.2–0.4 ml per dose, 0.6–1.2 ml daily; 0.2 ml three times daily at 8–11; not under 8; 30 minutes before meals; up to 3 months; contraindications; antacid, H2-blocker, and PPI warning; CYP3A4; pregnancy.
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Assessment report on Mentha x piperita L., folium and aetheroleum (Revision 1)
European Medicines Agency (EMA/HMPC/522409/2013), 2020
Heartburn from upper-gut release relaxing the lower esophageal sphincter; 0.2 ml equals about 182–187 mg; Kline pediatric trial details; ACG 2014 monograph rated evidence moderate; felodipine and rat cyclosporine studies; menthol apnea risk in infants.
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European Union herbal monograph on Mentha x piperita L., folium (Revision 1)
European Medicines Agency (EMA/HMPC/572705/2014), 2020
Peppermint leaf tea only as a traditional remedy for dyspepsia and flatulence; 1.5–3 g in 100–150 ml three times daily for adults; people with reflux should avoid it; not under 4; not recommended in pregnancy or lactation.
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Peppermint Oil
National Center for Complementary and Integrative Health (NIH), 2025
Updated May 2025: enteric-coated oil may improve IBS in adults; 2022 review of 10 studies; ACG 2021 recommendation; heartburn, nausea, abdominal pain, dry mouth; no menthol near infants’ faces; medicinal amounts in pregnancy unstudied.
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Irritable bowel syndrome in adults: diagnosis and management (CG61)
National Institute for Health and Care Excellence (NICE), 2017
Consider antispasmodics, taken as required, alongside diet and lifestyle advice (peppermint oil not named); red-flag referral; blood count, ESR or plasma viscosity, CRP, and celiac antibody tests before diagnosis.
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Diagnosis of Irritable Bowel Syndrome
National Institute of Diabetes and Digestive and Kidney Diseases (NIH), 2017
Symptoms suggesting another condition: anemia, rectal bleeding, bloody or black stools, weight loss; family history of celiac disease, colon cancer, or inflammatory bowel disease.