Black pepper: Stimulation of diarrhea in patient with underlying short bowel syndrome

Sir,

Black pepper is a well-known plant which has been widely used as regimen in ancient drug remedies. The antibacterial activity of the berries of black pepper is confirmed.[1] As an important drug in Indian Ayurveda remedies, black pepper's usefulness is also confirmed in the management of hyperglycemia and metabolic disruption.[23] Focusing on the gastrointestinal effect, there is a new evidence that piperine from black pepper can act against diarrhea.[4] However, we hereby present an observation against this recent finding. The patient is a case with underlying short bowel syndrome with controllable bowel frequency. The patient had just tried adding black pepper as an ingredient to her food and got the acute problem of diarrhea for more than 10 times per day. The stool examination and culture was done and the result was negative. After ceasing of using black pepper, there was complete relief from diarrhea. She performed a self-provocative test by adding black pepper into her food again and the diarrhea problem resurfaced. She also observed that more pepper resulted in greater frequency of diarrhea. The above case gives an interesting data against the observation that black pepper might be useful for control of diarrhea. It is also noted that the patient with underlying bowel disorder (such as short bowel syndrome or irritable bowel syndrome) should be aware of any Ayurveda regimen that may contain black pepper.