Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome
What this study found
Glutamine produced a marked clinical benefit in PI-IBS-D with intestinal hyperpermeability. A total of 43 of 54 participants (79.6%) in the glutamine group achieved at least a 50-point reduction in IBS-SS versus 3 of 52 (5.8%) with placebo (p<0.0001). End-of-treatment IBS-SS was 181.39±47.73 with glutamine versus 296.06±62.30 with placebo, stool frequency was 2.91±0.97 versus 5.26±2.08, stool consistency was 3.88±1.20 versus 6.57±0.53, and intestinal permeability improved to 0.05±0.01 versus 0.10±0.03; all between-group comparisons were p<0.0001. Adverse events were uncommon and similar…
- Study & population
- Randomized, placebo-controlled trial in adults aged 18-72 years with postinfectious IBS-D meeting Rome III criteria and documented intestinal hyperpermeability.
- Intervention
- Adults with postinfectious, diarrhea-predominant IBS and increased intestinal permeability received oral glutamine powder 5 g three times daily for 8 weeks, compared with placebo.
- Key limitation
- The trial was relatively small and limited to adults with postinfectious IBS-D and increased intestinal permeability, which narrows generalizability.
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Open PDFOriginal 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 NCT1414244; Results.