At IBS Days in Bologna, William Fusco, gastroenterologist at Gemelli University Hospital in Rome, discusses the role of peppermint oil in the management of disorders of gut–brain interaction. Peppermint oil can be considered a first-line option for abdominal pain in irritable bowel syndrome and for symptom relief in both functional dyspepsia phenotypes: epigastric pain syndrome and postprandial distress syndrome.

Treatment selection should nevertheless reflect the predominant clinical mechanism. In postprandial distress syndrome, a prokinetic may be preferred when impaired gastric motility is thought to play a major role. In epigastric pain syndrome, clinicians may instead choose between peppermint oil and a proton pump inhibitor.

When therapeutic efficacy is comparable, safety and long-term consequences can help guide the decision. Although proton pump inhibitors are generally considered safe, prolonged use may affect nutrient homeostasis and contribute to alterations in the intestinal microbiota. Peppermint oil, by contrast, may relieve functional dyspepsia symptoms while producing only limited changes in microbial composition. It may therefore represent a useful microbiota-sparing option, particularly when longer-term treatment is required.