Glutamine supplements highly effective in post-infectious IBS with diarrhea

Last Updated: 2018-08-23

By Reuters Staff

NEW YORK (Reuters Health) - Dietary glutamine supplements are an effective treatment for patients who develop irritable bowel syndrome with diarrhea (IBS-D) with increased intestinal permeability following an enteric infection, according to results of the first randomized, placebo-controlled, double-blind trial to test the treatment.

The study found that oral glutamine supplementation normalizes elevated intestinal permeability leading to improvement in diarrhea and abdominal pain.

Effective therapies for patients with postinfectious IBS-D "remain limited and unsatisfactory," Dr. G. Nicholas Verne from Tulane University School of Medicine, in New Orleans, and colleagues note in Gut, online August 14.

They assessed the safety and efficacy of eight weeks of oral glutamine (5 g thrice weekly) or placebo in 106 patients who developed IBS-D with increased intestinal permeability after an enteric infection. Fifty-four glutamine and 52 placebo subjects completed the study.

Glutamine treatment led to a marked increase in the proportion of patients who met or exceeded the primary endpoint of at least a 50-point decrease on the IBS Severity Scoring System, IBS-SS: 43 patients on glutamine (79.6%) versus three patients on placebo (5.8%), a 14-fold difference (P<0.0001).

Oral glutamine also significantly reduced all secondary endpoints; IBS-SS score at eight weeks (301 vs. 181), daily bowel-movement frequency (5.4 vs. 2.9), stool form (Bristol Stool Scale, 6.5 vs. 3.9) and intestinal permeability (0.11 vs. 0.05).

There was normalization of intestinal hyperpermeability (elevated urinary lactulose/mannitol ratios) in the glutamine arm but not the placebo arm, and this may be glutamine's mechanism of action, the researchers say.

Adverse events and rates of study-drug discontinuation were low and similar in the two groups and no serious adverse events occurred, they report.

In this study, they conclude, oral glutamine supplements "dramatically and safely" reduced all major IBS-related endpoints. They say further studies are now warranted, "with larger sample sizes; a wider dose range; ones that determine whether the effects of glutamine are enduring and safe over the longer term; ones that explore mechanisms; ones that evaluate glutamine in other types of IBS."

The study had no commercial funding and the authors have disclosed no conflicts of interest.

SOURCE: https://bit.ly/2nXKkQ6

Gut 2018.