Gastrim

Ingredients:

Crowfoot (Aconitum palmatum D. Don.) root
Black pepper (Piper nigrum L.) fruit
False black pepper (Embelia ribes Burm. f.) fruit
Ginger (Zingiber officinale Rosc.) rhizome
Triphala:
Amalaki (Emblica officinalis Gaertn.) fruit
Vibhitaka (Terminalia bellerica [Gaertn.] Roxb.) fruit
Haritaki (Terminalia chebula Retz.) fruit rind
Mint (Mentha arvensis L.) leaves
Lemon (Citrus limon [L.] Burm. f.) fruit
Papaya (Carica papaya L.) fruit



Gastrim® (previously called Gasex®) is manufactured by the
Himalaya Drug Company in India, and distributed in the United
States by Himalaya USA. Gastrim is also available under the name
GastriCare®. The current product label lists the ten herbal ingredients
indicated earlier. Also listed on the label, in the category of other
ingredients, are purified conch shell ash and purified cowrie shell ash.
The recommended dose is one to two 515 mg tablets, before meals or
as needed.

The material used in one of the clinical trials is described as tablets
containing 214 mg total ingredients. The dose in the trialwas two tablets
three times a day, for a total of 1.28 g per day. The ingredients and
their quantities were listed in one trial report as Aconitum palmatum
(65 mg), Piper nigrum (19 mg), extract of Embelia ribes (22 mg), extract
of Triphala (22 mg), extract of Zingiber officinale (22 mg),
cowrie bhasma (purified cowrie shell ash) (32 mg), and shankh
bhasma (purified conch shell ash) (32 mg)—all prepared in the juices
and decoctions of Mentha arvensis, Moringa pterygosperma, Carica
papaya, Citrus limon, etc. (Chandra et al., 1978). The other clinical
trial did not provide a list of product ingredients (Mishra and Singh,
1981). The current product differs from that described in the trial in
that Moringa pterygosperma is not mentioned on the label.


Dyspepsia (Indigestion)

A trial included 100 patients with symptoms of dyspepsia (indigestion)
who were given either Gasex or placebo for two weeks. The
dose of Gasex was two tablets three times daily for one week, and
then two tablets twice daily for the second week. Thirty-six of the 50
patients in the placebo group did not have any response after two
weeks and were switched to Gasex treatment. Of all the subjects
given Gasex, 71 of 86 were judged as having a good to excellent therapeutic
response (Mishra and Singh, 1981). Our reviewers, Drs.
Karriem Ali and Richard Aranda, commented that the crossing over
of the placebo nonresponders to the treatment arm, without any distinction
in the reporting of the results, obscures the purpose of having
a placebo group.


Postoperative Gastric Distress

Another trial with Gasex studied 150 women recovering from
gynecological surgery. Treatment began on the postoperative day at
the onset of bowel sounds, with either Gasex (two tablets three times
daily) or vitamin B complex tablets as placebo, and continued for one
to two weeks. All patients taking Gasex showed considerable improvement
in symptoms compared to the controls. In the Gasex
group, a good to excellent response was observed in 95 percent of patients
with abdominal discomfort, and in 88 percent with flatulence,
compared to 14 percent and 4 percent of the control group, respectively
(Chandra et al., 1978). The randomization and blinding processes
were inadequate, and the use of vitamin B complex as placebo
was not explained.