IBS - Irritable Bowel Syndrome
Conditions
Brief summary
Impaired intestinal permeability and microbial dysbiosis are important pathophysiological mechanisms underlying irritable bowel syndrome (IBS). ReFerm®, also called Profermin®, is a postbiotic product of oat gruel fermented with Lactobacillus plantarum 299v. In this experimental study, we investigated whether ReFerm® has a beneficial effect on the intestinal epithelial barrier function in patients with IBS.
Detailed description
A single-blinded, randomised experimental study was conducted. Potential participants were screened based on the inclusion and exclusion criteria during telephone interviews. As the patients were their own controls, self-reported allergy was not an exclusion criterion as long as both interventions were carried out during unchanged allergic exposure. Patients were then randomly allocated to one of two study arms: Referm® or thickened water (Thick-it ®, commercially available; Kent Precision Foods Group, Inc., Muscatine, IA, USA) as placebo. The patients underwent sigmoidoscopy with biopsies obtained from the distal colon at baseline and after 14 days of intervention with ReFerm® or placebo enema twice a day. The enema was administered rectally, in the left side position, and retained for as long as possible (at least 10 min) both in the left-sided and supine body position to activate retrograde peristalsis. To assess clinical improvement of symptoms, questionnaires were completed twice: before and after the intervention. During the 14 days of the intervention, the patients completed daily questionnaires. To improve compliance with the study intervention, the patients were given a check-up call by a principal investigator (OBe) twice per week during the intervention period.
Interventions
DIETARY_SUPPLEMENTReFerm(R)
Enemas of approx 250 mL twice daily
Sponsors
University Hospital, Linkoeping
Linkoeping University
Nordisk Rebalance A/S
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
DOUBLE (Subject, Caregiver)
Masking description
The appearance including colour and thickness of the two products are similar
Intervention model description
Patients were randomly allocated to ReFerm® (18 patients, two men) or placebo (12 patients, three men) arms. There were no significant differences between the groups in terms of age, BMI, or disease severity.
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Confirmed IBS-D or IBS-M according to Rome IV criteria * Moderate to severe IBS according to IBS-SSS score (≥175p) * Age 18-70 years * Fluency in written and spoken Swedish language
Exclusion criteria
* Organic gastrointestinal disease * Previous major gastrointestinal operation (apart from appendectomy and cholecystectomy) * Psychiatric disease (bipolar disease, schizophrenia) * NSAID intake less than 2 weeks prior to endoscopy * Self-reported pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intestinal permeability | 14 days | Basic Science. Mucosal permeability change (transcellular (amount of HRP (fmol/mL) and paracellular (amount of FITC (pM)), before and after treatment using an Ussing chamber with mounted patient biopsies |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Symptom change | 14 days | Symptom change using the following questionnaires systems. IBS severity scoring system for symptom change (significant if \> 50 points) before and after treatment. Gastrointestinal Symptom Rating Scale-IBS and Visceral sensitivity index. Data analyzed by cluster or as a total score for all items with statistically significant change. Hospital Anxiety and Depression Scale. Cut-off values are indicated as ≥8 for subclinical (suspicious) anxiety or depression and ≥11 as definite cases on both the HADS-D and HADS-A, respectively. Short Health Scale. Data analyzed by cluster or as a total score for all items with statistically significant change. |
Countries
Sweden
Outcome results
None listed