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Plantas medicinais usadas para prevenção e tratamento de distúrbios gastrointestinais e sua qualidade. Estudo de caso
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Orientador(es)
Resumo(s)
Os distúrbios funcionais do trato gastrointestinal (DFTG) consistem num grupo de doenças muito frequentes em gastrenterologia e podem traduzir-se como combinações variáveis de sinais ou de sintomas crónicos (ou recorrentes) e agudos do aparelho digestivo. Entre os distúrbios mais reconhecidos destaca-se a dispepsia funcional (DF), a qual consiste numa síndrome que compreende sintomas crónicos da região gastroduodenal, como sensação de plenitude pós-prandial recorrente, saciedade precoce, dor e/ou ardor epigástrico. No que diz respeito à abordagem clínica desta doença, o primeiro passo consiste na realização de anamnese orientativa das estratégias de diagnóstico e de terapêutica farmacológica futuras.
O recurso a produtos de saúde à base de plantas (PSBP) para a prevenção e o tratamento de sintomas de desconforto gastrointestinal é cada vez mais generalizado, integrando o uso de substâncias derivadas de plantas, preparações tradicionais à base destas, alimentos ou suplementos alimentares. Embora as plantas medicinais mais usadas na Europa detenham maioritariamente monografia de qualidade na Farmacopeia Europeia e sejam passíveis de utilização sob a forma de medicamento tradicional à base de plantas, a maioria destas plantas medicinais é atualmente comercializada em Portugal sob a forma de alimento ou de suplemento alimentar. Estas últimas, são categorias legais que se encontram fora do controlo da agência reguladora do medicamento – Infarmed, por isso não sujeitas aos mesmos requisitos de qualidade, segurança e eficácia do que os medicamentos, levando a uma crescente preocupação no que se refere à sua segurança e à prevenção da sua fraude.
O presente trabalho visa, a partir da identificação dos PSBP mais vendidos para a prevenção e/ou tratamento de distúrbios gastrointestinais em Portugal em circuito farmacêutico, a identificação dos correspondentes a plantas medicinais com monografia da Agência Europeia do Medicamento (EMA) e, sobre estas, a identificação de estudos relativos à sua adulteração.
Os resultados obtidos mostraram que as plantas medicinais de maior comercialização, objeto de monografia pela EMA, são a alcachofra, folha, o cardo-mariano, fruto e o gengibre, rizoma.
Os resultados da revisão da literatura efetuada confirmaram serem estas 3 plantas medicinais objeto de adulteração, e de entre estas, a alcachofra, folha a que reúne um menor número de artigos científicos neste âmbito. Por seu turno, tanto o cardo mariano, fruto bem como o gengibre, rizoma foram objeto de estudos cujos resultados mostraram a necessidade de maior rigor no controlo de qualidade, por serem passíveis de adulteração, em si mesmas, ou serem adulterantes de outras plantas medicinais.
A realização de mais estudos de controlo de qualidade visando as plantas medicinais e respetivos produtos de saúde à base destas, comercializados como alimentos, suplementos alimentares e/ou medicamentos à base de plantas, é para nós premente pois são normalmente produtos de venda livre num mercado em crescimento e que podem ser alvo de diversos tipos de adulterações, intencionais ou não, o que representa um risco para a saúde pública.
Functional disorders of the gastrointestinal tract (FDGT) are a group of diseases that are very common in gastroenterology and can be defined as variable combinations of chronic (or recurrent) symptoms of the digestive tract. Among the most recognized disorders, functional dyspepsia (FD) stands out, which is a syndrome comprising chronic symptoms of the gastroduodenal region, such as recurrent postprandial fullness, early satiety, pain and/or epigastric burning. About the clinical approach to this disease, the first step is to carry out an anamnesis to guide future diagnostic and therapeutic strategies. The use of herbal health products (PSBP) for the prevention and treatment of symptoms of gastrointestinal discomfort is increasingly widespread, integrating the use of herbal substances, traditional herbal preparations, foods, or food supplements. Although the most widely used medicinal plants in Europe have quality monographs in the European Pharmacopoeia, and can be used as traditional herbal medicines, most of these medicinal plants are currently marketed in Portugal in the form of food or food supplements. The latter are legal categories that are outside the control of the drug regulatory agency – Infarmed, therefore not subject to the same quality, safety, and efficacy requirements as drugs, and leading to a growing concern with regard to their safety and the prevention of its fraud. This work aims, from the identification of the most sold herbal health products for the prevention and/or treatment of gastrointestinal disorders in Portugal in the pharmaceutical circuit, the identification of those corresponding to medicinal plants with a monograph of the European Medicines Agency (EMA) and, on these, the identification of studies related to their adulteration. The results obtained showed that artichoke, leaf, milk thistle, fruit and ginger, rhizome are the medicinal plants of greatest commercialization object of monograph by EMA. The results of the literature review carried out confirmed that these 3 medicinal plants are subject to adulteration, and among these, the artichoke, a leaf that gathers a smaller number of scientific articles in this area. In turn, both milk thistle, fruit and ginger, rhizome were the object of studies whose results showed the need for greater rigor in quality control, as they are subject to adulteration, in themselves, or are adulterants of other medicinal plants. Carrying out more quality control studies targeting medicinal plants and respective health products based on them marketed as foods, food supplements and/or herbal medicines, is urgent for us as they are normally over-the-counter products in a market growing and that can be the target of different types of adulteration, intentional or not, which represents a risk to public health.
Functional disorders of the gastrointestinal tract (FDGT) are a group of diseases that are very common in gastroenterology and can be defined as variable combinations of chronic (or recurrent) symptoms of the digestive tract. Among the most recognized disorders, functional dyspepsia (FD) stands out, which is a syndrome comprising chronic symptoms of the gastroduodenal region, such as recurrent postprandial fullness, early satiety, pain and/or epigastric burning. About the clinical approach to this disease, the first step is to carry out an anamnesis to guide future diagnostic and therapeutic strategies. The use of herbal health products (PSBP) for the prevention and treatment of symptoms of gastrointestinal discomfort is increasingly widespread, integrating the use of herbal substances, traditional herbal preparations, foods, or food supplements. Although the most widely used medicinal plants in Europe have quality monographs in the European Pharmacopoeia, and can be used as traditional herbal medicines, most of these medicinal plants are currently marketed in Portugal in the form of food or food supplements. The latter are legal categories that are outside the control of the drug regulatory agency – Infarmed, therefore not subject to the same quality, safety, and efficacy requirements as drugs, and leading to a growing concern with regard to their safety and the prevention of its fraud. This work aims, from the identification of the most sold herbal health products for the prevention and/or treatment of gastrointestinal disorders in Portugal in the pharmaceutical circuit, the identification of those corresponding to medicinal plants with a monograph of the European Medicines Agency (EMA) and, on these, the identification of studies related to their adulteration. The results obtained showed that artichoke, leaf, milk thistle, fruit and ginger, rhizome are the medicinal plants of greatest commercialization object of monograph by EMA. The results of the literature review carried out confirmed that these 3 medicinal plants are subject to adulteration, and among these, the artichoke, a leaf that gathers a smaller number of scientific articles in this area. In turn, both milk thistle, fruit and ginger, rhizome were the object of studies whose results showed the need for greater rigor in quality control, as they are subject to adulteration, in themselves, or are adulterants of other medicinal plants. Carrying out more quality control studies targeting medicinal plants and respective health products based on them marketed as foods, food supplements and/or herbal medicines, is urgent for us as they are normally over-the-counter products in a market growing and that can be the target of different types of adulteration, intentional or not, which represents a risk to public health.
Descrição
Tese de mestrado, Qualidade Alimentar e Saúde, 2021, Universidade de Lisboa, Faculdade de Farmácia
Palavras-chave
Adulteração Cynara cardunculus subsp. flavescens L. Dispepsia Plantas medicinais Silybum marianum (L.) Gaertn Zingiber officinale Roscoe Teses de mestrado -2021