SupplementStrong evidenceDigestion

Iberogast (STW 5)

Nine-herb fixed combination with the strongest RCT base for functional dyspepsia in the natural-medicine catalogue.

Why

Iberogast (STW 5) is a fixed combination of nine herbal extracts, Iberis amara, peppermint, chamomile, caraway, liquorice, lemon balm, angelica, milk thistle, and celandine, sold widely across Europe for functional dyspepsia and IBS. Multiple RCTs and a network meta-analysis place STW 5 alongside cisapride and metoclopramide for global symptom improvement, with a generally favourable safety profile. A 2018 EMA review reaffirmed its benefit/risk balance while strengthening the rare hepatotoxicity warning, celandine content has since been removed in some markets.

How it works

Region-specific dual action on gastric motility, relaxant in the antrum/pylorus (mints, liquorice) and tonic in the proximal stomach (Iberis amara), addressing the impaired gastric accommodation typical of functional dyspepsia. Additional antispasmodic, carminative, and mucosal-protective effects.

Expected onset · Symptom improvement often within 2 weeks; trials run 4–8 weeks

How to take

Dosage

20 drops three times daily before or with meals, for up to 4–8 weeks.

Timing

Before or with each main meal

On the label

STW 5 (original) or STW 5-II (celandine-free), match the form to local availability. Generic 'bitter blends' are not equivalent.

Ideal for

Adults with functional dyspepsia (epigastric discomfort, early satiety, postprandial fullness) or IBS-overlap symptoms.

Safety

Rare but real hepatotoxicity reports, mostly linked to the celandine (Chelidonium) component, newer formulations (STW 5-II) omit celandine. Stop and seek medical advice for any unexplained jaundice, nausea, or right-upper-quadrant pain. Contains ethanol. Avoid in pregnancy, breastfeeding, alcohol-use disorder, and severe liver disease.

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Evidence

At a glance

Ottillinger 2013 Wien Med Wochenschr meta-analysis (6 RCTs, n>500): STW 5 significantly reduced functional dyspepsia symptoms vs placebo, with effect sizes comparable to cisapride and metoclopramide in head-to-head trials. Madisch 2004 Aliment Pharmacol Ther RCT (n=315): GI symptom score reduced 6.9 vs 4.4 points on placebo over 8 weeks. Hepatotoxicity signal led to celandine being reviewed and removed from some formulations.

Where to get it

Shop Iberogast (STW 5) on Amazon

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