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Zhou Q, Verne ML, Fields JZ, Lefante JJ, Basra S, Salameh H, Verne GN. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut 2019; 68:996-1002. [PMID: 30108163 PMCID: PMC9549483 DOI: 10.1136/gutjnl-2017-315136] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 07/19/2018] [Indexed: 12/12/2022]
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 NCT01414244; Results.
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Affiliation(s)
- QiQi Zhou
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA,Department of Veteran Affairs, Malcom Randall VAMC, Gainesville, FL
| | | | - Jeremy Z. Fields
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - John J. Lefante
- Department of Global Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Sarpreet Basra
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Habeeb Salameh
- Department of Medicine, University of Texas Medical Branch, Galveston, TX
| | - G. Nicholas Verne
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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Goichon A, Bahlouli W, Ghouzali I, Chan P, Vaudry D, Déchelotte P, Ducrotté P, Coëffier M. Colonic Proteome Signature in Immunoproteasome-Deficient Stressed Mice and Its Relevance for Irritable Bowel Syndrome. J Proteome Res 2018; 18:478-492. [DOI: 10.1021/acs.jproteome.8b00793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexis Goichon
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
| | - Wafa Bahlouli
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
| | - Ibtissem Ghouzali
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
| | - Philippe Chan
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Platform in proteomics PISSARO, Normandie University, UNIROUEN, Rouen, F-76821, France
| | - David Vaudry
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Platform in proteomics PISSARO, Normandie University, UNIROUEN, Rouen, F-76821, France
- INSERM unit 1239, Normandie University, UNIROUEN, Rouen, F-76821, France
| | - Pierre Déchelotte
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Nutrition Department, Rouen University Hospital, Rouen, F-76031, France
| | - Philippe Ducrotté
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Gastroenterology Department, Rouen University Hospital, Rouen, F-76031, France
| | - Moïse Coëffier
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Nutrition Department, Rouen University Hospital, Rouen, F-76031, France
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Simrén M, Tack J. New treatments and therapeutic targets for IBS and other functional bowel disorders. Nat Rev Gastroenterol Hepatol 2018; 15:589-605. [PMID: 29930260 DOI: 10.1038/s41575-018-0034-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Functional bowel disorders (FBDs) are a spectrum of disorders characterized by combinations of symptoms attributable to the lower gastrointestinal tract. Most current first-line therapies for IBS and other FBDs target the predominant symptom and mainly affect one symptom in the symptom complex. Additional broadly effective treatment alternatives targeting the entire symptom complex are needed. New drugs for FBDs (such as lubiprostone, linaclotide, plecanatide, prucalopride, eluxadoline and rifaximin) target key mechanisms in the pathophysiology of these disorders and improve both the abnormal bowel habit and other key symptoms, such as abdominal pain and bloating. The current development of new treatment alternatives is focusing on different aspects of the complex pathophysiology of IBS and other FBDs: gut microenvironment (via diet and modulation of gut microbiota), enterohepatic circulation of bile acids, gastrointestinal secretion, motility and sensation, gut-brain interactions, gut barrier function and the immune system within the gastrointestinal tract. Studies also suggest that personalized treatment of IBS and other FBDs is possible using various diagnostic markers.
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Affiliation(s)
- Magnus Simrén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA.
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
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Achamrah N, Déchelotte P, Coëffier M. Glutamine and the regulation of intestinal permeability: from bench to bedside. Curr Opin Clin Nutr Metab Care 2017; 20:86-91. [PMID: 27749689 DOI: 10.1097/mco.0000000000000339] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Glutamine is the most abundant amino acid in plasma and plays a key role in maintaining the integrity of intestinal barrier. RECENT FINDINGS Experimental studies showed that glutamine is able to modulate intestinal permeability and tight junction protein expression in several conditions. Recent articles underlined its putative beneficial role in gastrointestinal disorders such as irritable bowel syndrome. SUMMARY Glutamine is a major nutrient to maintain intestinal barrier function in animals and humans. Depletion of glutamine results in villus atrophy, decreased expression of tight junction proteins and increased intestinal permeability. Moreover, glutamine supplementation can improve gut barrier function in several experimental conditions of injury and in some clinical situations. Furthermore, preventive effects of glutamine in experimental models of intestinal injuries have been recently reported. Despite promising data in experimental models, further studies are needed to evaluate glutamine supplementation in clinical practice.
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Affiliation(s)
- Najate Achamrah
- aNormandie Univ bINSERM UMR 1073 'Nutrition, Inflammation and Dysfunction of Gut-brain Axis', University of Rouen cNutrition Department, Rouen University Hospital, Rouen, France
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