Format

Send to

Choose Destination
Gut. 2018 Aug 14. pii: gutjnl-2017-315136. doi: 10.1136/gutjnl-2017-315136. [Epub ahead of print]

Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome.

Author information

1
Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
2
Department of Veteran Affairs, Malcom Randall VAMC, Gainesville, Florida, USA.
3
Health Sciences, Texas A&M University, College Station, Texas, USA.
4
Department of Global Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.
5
Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA.

Abstract

BACKGROUND:

More effective treatments are needed for patients with postinfectious, diarrhoea-predominant, irritable bowel syndrome (IBS-D). Accordingly, we conducted a randomised, double-blind, placebo-controlled, 8-week-long trial to assess the efficacy and safety of oral glutamine therapy in patients who developed IBS-D with increased intestinal permeability following an enteric infection.

METHODS:

Eligible adults were randomised to glutamine (5 g/t.i.d.) or placebo for 8 weeks. The primary end point was a reduction of ≥50 points on the Irritable Bowel Syndrome Severity Scoring System (IBS-SS). Secondary endpoints included: raw IBS-SS scores, changes in daily bowel movement frequency, stool form (Bristol Stool Scale) and intestinal permeability.

RESULTS:

Fifty-four glutamine and 52 placebo subjects completed the 8-week study. The primary endpoint occurred in 43 (79.6%) in the glutamine group and 3 (5.8%) in the placebo group (a 14-fold difference). Glutamine also reduced all secondary endpoint means: IBS-SS score at 8 weeks (301 vs 181, p<0.0001), daily bowel movement frequency (5.4 vs 2.9±1.0, p<0.0001), Bristol Stool Scale (6.5 vs 3.9, p<0.0001) and intestinal permeability (0.11 vs 0.05; p<0.0001). 'Intestinal hyperpermeability' (elevated urinary lactulose/mannitol ratios) was normalised in the glutamine but not the control group. Adverse events and rates of study-drug discontinuation were low and similar in the two groups. No serious adverse events were observed.

CONCLUSIONS:

In patients with IBS-D with intestinal hyperpermeability following an enteric infection, oral dietary glutamine supplements dramatically and safely reduced all major IBS-related endpoints. Large randomised clinical trials (RCTs) should now be done to validate these findings, assess quality of life benefits and explore pharmacological mechanisms.

TRIAL REGISTRATION NUMBER:

NCT 1414244; Results.

KEYWORDS:

diarrhoea; enteric infections; intestinal permeability; irritable bowel syndrome

PMID:
30108163
DOI:
10.1136/gutjnl-2017-315136

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center