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Does ginger prevent nausea and vomiting?



Clinical bottom line: There is insufficient evidence to show whether ginger is an effective anti-emetic. Included studies were of good methodological quality, but were small and assessed a variety of different conditions.

Systematic review:

Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomised clinical trials. British Journal of Anaesthesia 2000; 84(3): 367-71.



Date review completed: November 1997

Number of trials included: 6

Number of patients: (See below)

Control groups: placebo, metoclopramide.

Main outcomes: nausea symptoms, vomiting, symptom severity.

Inclusion criteria were randomised, double blind, controlled trials of ginger monopreparations for nausea and vomiting.

Medline, Embase, Biosis, CICSOM and the Cochrane Library were searched (to January 1998) for published reports. The reviewers' own files were searched for relevant studies. Bibliographies of retrieved trials and reviews were checked for additional citations and no language restrictions were made. Manufacturers of ginger preparations and experts were contacted for published and unpublished trials. Data were extracted in a standardised, predefined manner by the two reviewers. Methodological quality was rated using a validated 5-point scale. A meta-analysis was conducted for studies which assessed postoperative nausea. Relative benefit, with 95% confidence intervals, was calculated.


Findings:

Seasickness:

One study assessed a single dose of ginger 1 g or placebo in 80 cadets. Symptoms of seasickness were assessed over four hours. Significantly fewer cadets reported seasickness with ginger 1 g than with placebo after four hours.

 

Hyperemesis gravidarum:

One cross-over trial assessed 27 women with severe nausea during pregnancy. Women were given ginger 250 mg four times daily or placebo for four days and sickness was rated using a symptom score. Significantly fewer women reported sickness with ginger compared with placebo.

 

Chemotherapy-induced nausea:

One study assessed the effectiveness of ginger (dose not stated) or placebo on the symptoms of nausea in 41 patients with leukaemia. Significantly less severe nausea was reported with ginger than with placebo.

 

Postoperative nausea and vomiting:

Three studies assessed postoperative nausea and vomiting in women after laparoscopic or gynaecological surgery.

Early emetic events:

One trial assessed a single dose of oral ginger 0.5 g compared with placebo in 108 women after laparoscopic surgery. Nausea and vomiting was assessed over three hours. The proportion of patients with nausea was 33% (12/36 patients) with ginger 0.5 g, 36% (13/36) with ginger 1.0 g and 22% (8/36) with placebo (Figure 1). The proportion of patients with vomiting was 14% (5/36 patients) with ginger 0.5 g, 30% (11/36) with ginger 1.0 g and 17% (6/36) with placebo (Figure 2). There was no significant difference between ginger 0.5 g or ginger 1.0 g and placebo. For nausea, the relative risks were 1.5 (0.7 to 3.2) and 1.6 (0.8 to 3.4) respectively. For vomiting, the relative risks were 0.8 (0.3 to 2.5) and 1.8 (0.8 to 4.4) respectively.

Late emetic events:

Two placebo controlled studies assessed nausea and vomiting over the first 24 hours after surgery in women who had had gynaecological or laparoscopic surgery. Study medications were given to patients before surgery.

One trial assessed single-dose oral ginger powder 1 g or intramuscular metoclopramide 10 mg in 60 women. The proportion of patients with nausea and/or vomiting was 45% (9/20 patients) with ginger 1 g, 50% (10/20) with metoclopramide and 70% (14/20) with placebo. There was no significant difference between ginger or metoclopramide compared with placebo for nausea and/or vomiting over 24 hours; the relative risks were 0.6 (0.4 to 1.1) and 0.7 (0.4 to 1.2) respectively.

The other trial assessed oral ginger powder 2 g or oral metoclopramide 20 mg in 120 women. The proportion of patients with nausea was 47% (19/40) with ginger, 52% (21/40) with metoclopramide and 67% (19/40) with placebo over 24 hours (Figure 1). The proportion of patients with vomiting was 10% (4/40) with ginger, 17% (7/40) with metoclopramide and 22% (9/40) with placebo over 24 hours (Figure 2). There was no significant difference between ginger or metoclopramide compared with placebo for nausea or vomiting over 24 hours. For nausea the relative risks were 0.8 (0.5 to 1.1) for ginger compared with placebo, and 1.1 (0.7 to 1.7) for metoclopramide compared with placebo. For vomiting, the relative risks were 0.4 (0.2 to 1.3) and 0.8 (0.3 to 1.9) respectively.

 

 

 

 


Adverse effects

Adverse effects were mentioned in two of the postsurgical studies. One simply stated that there was no difference between study treatments. In the other study, heartburn, bloated feeling and burping occurred infrequently.

 

Comment

Most of the results presented in the review were based on information from single, small trials. The most information was from trials which assessed ginger in postoperative nausea and vomiting; no significant difference between ginger and placebo was found in these small trials. Ginger is commonly used to prevent seasickness or motion sickness. The single study which assessed this found ginger to be effective, but had only 80 patients. There may be some benefit of ginger in preventing motion sickness, but at present there is insufficient evidence to say whether it works or not. Larger trials of good methodological quality are required.


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Identifier

AT128 - 6131 DOES GINGER PREVENT NAUSEA AND VOMITING: Sep-2000