Is there any evidence Is there any evidence support effectiveness of support effectiveness of

coffee enema?coffee enema?Truth and MythTruth and Myth

Pisaln Mairiang MD.Pisaln Mairiang MD.

Searching strategy

• Pubmed (no limit)

Keywords: Coffee enema,

Colonic hydrotherapy

Colonic irrigation

Searching: coffee enema

Historical aspects of enema therapyHistorical aspects of enema therapy

• An ancient theory of autointoxication by intestinal waste products.

• Had been practicing among ancient Chinese, Hindu, Egyptian medicine

NJ Taffinder et al Colorectal disease 2004;6:258-60

IndicationsIndications

asthma,allergies, arthritis, back pain, headache, insomnia, hyperlipidemia, bad breath, hypertension, mental disorders, alcoholism, ulcerative colitis, cancers and liver insufficiency.

Gerson’s hypothesis

Bacterial and food waste product

Bile flow

Alteration of Immune system

asthmaallergies arthritis

intoxication

headache, insomnia,

bad breath, mental disorders,

cancers and liver insufficiency.

Bile salt enterohepatic recirculationBile salt enterohepatic recirculation

Gerson’s hypothesis

Bacterial and food waste product

Bile flow

Repair of Immune system

asthmaallergies arthritis

detoxication

headache, insomnia,

bad breath, mental disorders,

cancers and liver insufficiency.

Scientific background of coffee enema

• Anaerobic decreased energy production and promote

cancer

• Coffee stimulate bile formation and flow

• Colestol compounds present in coffee act as

detoxicants by stimulate liver GST

• Cancer cells can be killed by inflammatory

reaction

NO

NO

NO

Yes/No

Coffee enema and cancerCoffee enema and cancer

tumor No. response Clinical course

melanoma 9 n/a Within natural history

Prostatemetastasis

21

n/acr

Within natural historyElevation of AP return to normal

Breast 2 n/a Residue mass post biopsy

Low gradelymphoma

3 1cr2n/a

2 with convention treatment1 regressed

endometrium 3 1cr1n/a1pd

1 ca in situ1 hysterectomy

Ca cervix 1 n/a 1a with conization

astrocytoma 1 pd Slow progresive disease

gastrinoma 1 pd Liver met and slow progressive

pancreas 2 2n/a No tissue prove

Hard palate 1 sd Positive biopsy

bladder 1 1cr Excision chemo and cystectomy

Leed A, et al. Lancet 1990;15:677-2

Safety and Safety and complicationscomplications

Complications of coffee enemaComplications of coffee enema

• Sporadic cases of deaths related to coffee enemas :• Pulmonary enema and septicemia in 46-year-old woman diagnosed as

colitis • 37-year-old woman with carcinoma of the breast developed

hyponathemia, hyperkalemia and abdominal pain with dyspnea

John W. Eisele, Donald T. Reay. JAMA 1980;244(14):1608-9.

• Perineal gangrene and rectal perforation Tan MP et al Ann Acad Singapore 1999;28:583-5

• Potassium depletion by enemas Dumning MF, Plum F. Am J Med 1956;789-92.

• Water intoxication Ziskind A, Gelis SS. J Dis Child 1958;699-04.

• Polymicrobial enteric septicemia from coffee enemasMargolin KA, Green MR. West J Med 1984;140(3):460

• Report cases of colonic injury (Burn) from Thai endoscopists

Summary on colonic hydrotherapySummary on colonic hydrotherapy

• Colonic hydrotherapy is effective in treatment constipation and hepatic encephalopathy

• There is no scientific evidence of its effectiveness

• To answer for effectiveness of coffee enema need controlled trail study. possible or impossible