The efficacy of ginger for the prevention of postoperative nausea and vomiting: A meta-analysis

doi:10.1016/j.ajog.2005.06.046

American Journal of Obstetrics and Gynecology

Volume 194, Issue 1, January 2006, Pages 95-99

https://doi.org/10.1016/j.ajog.2005.06.046 Get rights and content

Objective

The aim of this study was to specifically determine the impact of a fixed dose of ginger administration, compared with placebo, on the 24-hour postoperative nausea and vomiting.

Study design

The design was a systematic review and metaanalysis of trials revealed by searches. Randomized controlled trials comparing ginger with placebo to prevent postoperative nausea and vomiting and postoperative vomiting from Medline, IPA, CINAHL, Cochrane CENTRAL, HealthStar, Current Contents, bibliographies of retrieved articles, contact of authors, and experts in the field. Two reviewers selected studies for inclusion and independently extracted data.

Results

Five randomized trials including a total of 363 patients were pooled for analysis of preventing postoperative nausea and vomiting and postoperative vomiting. The summary relative risks of ginger for postoperative nausea and vomiting and postoperative vomiting were 0.69 (95% confidence interval 0.54 to 0.89) and 0.61 (95% confidence interval 0.45 to 0.84), respectively. Only one side effect, abdominal discomfort, was reported.

Conclusions

This meta-analysis demonstrates that a fixed dose at least 1 g of ginger is more effective than placebo for the prevention of postoperative nausea and vomiting and postoperative vomiting. Use of ginger is an effective means for reducing postoperative nausea and vomiting.

Section snippets

Search strategy

We searched the following databases: Medline, IPA, CINAHL, Cochrane CENTRAL, HealthStar, Current Contents, bibliographies of retrieved articles; we also contacted pharmaceutical companies, authors, and experts in the field. Key words for searching were ginger, Zingiber officinale, ingwer, ingber, nausea, vomiting, and postoperative nausea and vomiting. There was no language restriction.

Criteria for trial inclusion

Trials must meet the following inclusion criteria: (1) randomized, placebo-controlled trials evaluating

Results

Our search yielded a total of 59 potential studies. Fifty-three studies were excluded because they were not randomized, placebo-controlled trials. We identified a recent unpublished study in Thailand by contacting an expert.¹²

The study by Arfeen et al¹⁸ was excluded because only the incidence of 3-hour PONV was reported. The study by Eberhart et al¹⁹ was also excluded because the amount of ginger administered was only 0.3 or 0.6 g. Finally, we included a total of 5 studies involving 363

Comment

This study summarizes evidence from randomized, placebo-controlled trials evaluating the effectiveness of ginger for the prevention of PONV. We found that the incidence of PONV and POV in the ginger arm is 35% and 38%, respectively, lower than those in the placebo arm. Based on these findings, we conclude that ginger at a dose of 1 g or greater can significantly reduce the incidence of 24-hour PONV in patients undergoing gynecological and lower extremity surgery.

A systematic review by Morin et

Acknowledgment

The authors thank Professor Visanu Thamalikitkul, MD, MSc, for providing a citation of additional study.

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The overuse of antibiotics has resulted in Clostridium difficile infection (CDI) as a significant global public health concern. Studies have shown that imbalances in gut microbiota and metabolism play a vital role in the onset of CDI. Shengjiang Xiexin decoction (SJT), a traditional Chinese medicinal formula widely employed in the treatment of gastrointestinal ailments, demonstrates effectiveness in addressing murine CDI. However, the precise mechanistic role of SJT in CDI treatment remains uncertain, particularly regarding its impact on gut microbiota and intestinal metabolism. Thus, further investigation is imperative to shed light on these mechanisms.
This study aims to thoroughly investigate the therapeutic potential of SJT in the treatment of CDI, while also examining its impact on the intricate interplay between gut microbiota and bile acid metabolism. By employing a mouse model, we aspire to uncover novel insights that could pave the way for the development of more effective strategies in combating CDI.
We developed a mouse model for CDI and assessed SJT's potential as a therapeutic agent through pharmacological analyses. Our study employed high-throughput sequencing of 16S rRNA to identify changes in gut microbiota composition and untargeted metabolomics analysis to evaluate SJT's intervention on intestinal metabolism. We also conducted targeted analysis of bile acid metabolism to examine the specific effects of SJT. Finally, the growth-inhibitory effect of SJT on C. difficile was confirmed through ex vivo cultivation of the pathogen using cecal contents, supporting its potential role in treating CDI by modulating gut microbiota and bile acid metabolism.
In pharmacological studies, SJT was found to effectively reduce the levels of A&B toxins and alleviate colonic inflammation in CDI mice. Mechanistically, SJT demonstrated a mild increase in the abundance and diversity of the gut microbiota. However, its most significant impact was observed in the substantial improvement of the structural composition of the gut microbiota. Specifically, SJT decreased the abundance of gut Polymorphs and Firmicutes while restoring the proportions of family Trichophyton and Bacteroides_S24-7 spp (P < 0.001). Moreover, SJT not only decreased the levels of primary bile acids but also elevated the levels of secondary bile acids. Notably, it enhanced the conversion of taurocholic acid (TCA) to deoxycholic acid (DCA), leading to a balanced bile acid metabolism. Finally, cecal contents of SJT-treated mice showed a significant reduction in the growth of C. difficile, underscoring the therapeutic potential of SJT via modulation of gut microbiota and bile acid metabolism.
SJT demonstrates remarkable efficacy in treating CDI in mice by not only effectively combating the infection but also restoring the intricate balance of gut microbiota and bile acid metabolism. Furthermore, promising indications suggest that SJT may have the potential to prevent CDI recurrence. These findings underscore the comprehensive therapeutic value of SJT in managing CDI. Moving forward, we plan to transition from the laboratory to clinical settings to conduct further studies, validating our conclusions on SJT's efficacy.
Ginger (Zingiber officinale Roscoe) preparations for prophylaxis of postoperative nausea and vomiting: A Bayesian network meta-analysis
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Ginger has been proposed for prevention of postoperative nausea and vomiting (PONV), however it remains equivocal whether ginger can be an alternative option and which certain preparation is optimal for PONV prophylaxis.
We conducted a network meta-analysis (NMA) to compare and rank relative efficacy for PONV control among all available ginger preparations collected in the databases.
Eligible records were identified by retrieving Medline (via Pubmed), Embase, Web of Science, CENTRAL, CNKI, WHO ICTRP and ClinicalTrials.gov for randomized controlled trials that investigated the efficacy of ginger therapies for the prophylaxis of PONV. A bayesian NMA within random-effects models was implemented. Certainty of evidence for estimates was investigated following GRADE framework. We prospectively registered the protocol (CRD 42021246073) in PROSPERO.
Eighteen publications comprising 2199 participants with PONV were identified. Ginger oil (RR [95%CI], 0.39 [0.16, 0.96]) appeared to have the highest probability of being ranked best to decrease the incidence of postoperative vomiting (POV), with statistical significance compared with placebo, based on high to moderate confidence in estimates. With regard to reducing postoperative nausea (PON), statistically superiority was not observed in ginger regimens compared with placebo based on moderate to low certainty of evidence. Reduction in antemetic use and nausea intensity were noticed in ginger powder and oil. Ginger was significantly associated with better efficacy for Asian, older age, higher dosage, preoperative administration, hepatobiliary and gastrointestinal surgery.
Ginger oil appeared to be superior to other ginger treatments for the prophylaxis of POV. With regard to reducing PON, ginger preparations indicated no obvious advantages.
AGA Clinical Practice Update on Management of Medically Refractory Gastroparesis: Expert Review
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Citation Excerpt :
Although synthetic cannabinoids (eg, dronabinol, nabilone) are approved for chemotherapy-related nausea and vomiting, their use in gastroparesis has not been formally evaluated, with the potential to slow gastric emptying.33 Ginger improves nausea and vomiting but has not been prospectively evaluated in refractory gastroparesis.34 Erythromycin, a macrolide antibiotic, accelerates gastric emptying by binding to motilin receptors, thereby stimulating cholinergic activity in the antrum, and initiating phase III contractions of the migrating motor complex.35
Delayed gastric emptying on objective testing defines gastroparesis, but symptoms overlap with functional dyspepsia and do not correlate well with gastric emptying delay. This review outlines a strategy for defining, diagnosing, and managing refractory gastroparesis.
The Best Practice Advice statements presented here were developed from review of existing literature combined with expert opinion to provide practical advice. Because this was not a systematic review, formal rating of the quality of evidence or strength of recommendations was not performed.
- 1.
  Clinicians should review symptoms and evaluate physical examination findings to exclude disorders that can mimic medically refractory gastroparesis.
- 2.
  Clinicians should verify appropriate methodology of the gastric emptying study to ensure an accurate diagnosis of delayed gastric emptying.
- 3.
  Clinicians should classify patients with gastroparesis into mild, moderate, or severe based on symptoms and the results of a properly performed gastric emptying study.
- 4.
  Clinicians should identify the predominant symptom and initiate treatment based on that symptom.
- 5.
  Clinicians should be aware of the multiple treatment options to treat nausea and vomiting.
- 6.
  Clinicians should consider the use of neuromodulators to treat gastroparesis associated abdominal pain but should not use opioids.
- 7.
  Clinicians can consider gastric electrical stimulation for gastroparesis patients with refractory/intractable nausea and vomiting who have failed standard therapy and are not on opioids.
- 8.
  Clinicians can consider G-POEM for select refractory gastroparesis patients with severe delay in gastric emptying, using a thoughtful team approach involving motility specialists and advanced endoscopists at a center of excellence.
The preventive and relieving effects of ginger on postoperative nausea and vomiting: A systematic review and meta-analysis of randomized controlled trials
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Citation Excerpt :
Intake of ginger had no significant effect on vomiting, which may be due to the dose taken. One article (Chaiyakunapruk et al., 2006) included five trials with a total of 363 patients and concluded that at least 1 g of ginger was effective for reducing postoperative nausea and vomiting, and postoperative vomiting alone. However, in another article (Ernst and Pittler, 2000), the authors found that taking 1 g of ginger before surgery did not have a significant effect on postoperative nausea, so more trials are needed to determine the effective dose of ginger.
Postoperative nausea and vomiting are common uncomfortable symptoms experienced by patients. Besides drugs, non-pharmaceutical therapies such as herbal medicine therapy are available. Ginger has played a therapeutic role in patients undergoing chemotherapy and pregnant women, but results from postoperative patients are inconsistent.
The aim of this study was to examine and evaluate the preventive effect of ginger on postoperative nausea and vomiting.
A systematic review and meta-analysis of randomized controlled trials
Two independent researchers searched Chinese and English databases from their inception dates to November 2020. The Chinese databases used were CNKI and SinoMed, and the English databases used were PubMed, Embase, and the Cochrane Library. We only included randomized controlled trials. The primary outcomes were nausea score, presented as standard mean difference, and the number of vomiting episodes, presented as risk ratio. The secondary outcomes were side effects and antiemetic drug use, presented as risk ratios. We used the random-effects model.
Fourteen randomized trials with a total of 1,506 patients were pooled. At the different time points, the control group had higher postoperative nausea scores than the experimental group, and the differences were significant between the ginger and placebo groups at 2, 6, and 12 h after operation, with standard mean differences and 95% confidence intervals of −1.10 and −1.95 to −0.25, −1.54 and −3.05 to −0.03, and −2.04 and −3.67 to −0.41, respectively. Except in the recovery room, no statistically significant correlation was found between ginger intake and postoperative vomiting, postoperative nausea and vomiting, or antiemetic drug use.
The results of this meta-analysis demonstrate that ginger can reduce postoperative nausea but showed no significant difference in the incidence rates of postoperative vomiting, postoperative nausea and vomiting, and antiemetic drug use. More high-quality and rigorous trials are needed to elucidate the relationship between ginger intake and the reduction in the incidence of postoperative nausea and vomiting.
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The present systematic review and meta-analysis were conducted to investigate the effects of ginger on biomarkers of oxidative stress such as glutathione peroxidase (GPx), malondialdehyde (MDA), and total antioxidant capacity (TAC) this meta-analysis was performed.
Five databases were searched from inception to May 2020 using relevant keywords. Results were reported as bias-corrected standardized mean difference (Hedges' g) with 95 % confidence intervals (CI) using random-effects models.
Eleven RCTs were included. Ginger resulted in significantly increased on GPx (Hedges' g: 1.93, 95 % CI: 0.20 to 3.66, P = 0.029) and significant reduction in MDA (Hedges' g: −1.45, 95 % CI: −2.31 to −0.59, P = 0.001), but no significant change in TAC (Hedges' g: 0.42, 95 % CI: −0.03 to 0.88, P = 0.069). Greater reduction in MDA was detected in trials using ≤1 g ginger, lasted <12 weeks, participants aged ≥30 years old, among both gender and were conducted sample size ≤40. TAC was increased by administered high doses of ginger, lasted ≥12 weeks, mean age ≥30, sample size >40, and both gender and female.
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A herbal formulation (Tamzin) based on ginger and tamarind in combination with other natural ingredients for relieving motion sickness was studied. The proximate composition, polyphenols and vitamins content of the product were determined. The average values for moisture, carbohydrate, crude protein, fat, ash and crude fiber were 3.9, 85, 5.9, 1.4, 1.7 and 1.8%, respectively. In general, the sensory characteristics of both fresh and 6 month stored products had overall acceptability values of 8.5 and 7.9, respectively, on a 9-point hedonic scale. Seven-day oral administration of Tamzin aqueous extract (TE) to BALB/c mice significantly reduced the rotation-induced gastrointestinal symptoms such as conditioned gaping, defecation levels and locomotion activity. The extract also inhibited the histamine release in KU812 cells and showed no adverse effect up to 5 mg/mL concentration measured using 3-(4,5-dimethyl-2-yl)-2,5-diphenyltetrazolium bromide and lactate dehydrogenase leakage assays. The study showed that the formulation can provide beneficial health effects in alleviating symptoms caused by motion-sickness.

View all citing articles on Scopus

: Supported by a grant from the Thailand Research Fund and School of Pharmacy's grant for young researchers.

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General Obstetrics and Gynecology: GynecologyThe efficacy of ginger for the prevention of postoperative nausea and vomiting: A meta-analysis

Objective

Study design

Results

Conclusions

Section snippets

Search strategy

Criteria for trial inclusion

Results

Comment

Acknowledgment

Br J Anaesth

Control Clin Trials

Life Sci

Post-operative nausea and vomiting (PONV): a review article

Indian J. Anaesth

Postoperative nausea and vomiting: review and clinical approaches

SMJ

A postoperative analysis of parent's view of anesthesia in a Netherlands teaching hospital

Anesthesia

Postoperative nausea and vomiting-can it be eliminated?

JAMA

The study of postoperative nausea and vomiting

Br J Anaesth

Postoperative nausea and vomiting

Anaesthesist

Treatment of postoperative nausea and vomiting

BMJ

Rational approach to the control of postoperative nausea and vomiting; evidence from systemic reviews. Part I. Efficacy and harm of antiemetic interventions, and some methodological issues

Acta Anaesthesiol Scand

Disturbing post-operative symptoms are not reduced by prophylactic antiemetic treatment in patients at high risk of post-operative nausea and vomiting

Acta Anaesthesiol Scand

Ginger: history and use

Adv Ther

General Obstetrics and Gynecology: Gynecology
The efficacy of ginger for the prevention of postoperative nausea and vomiting: A meta-analysis