Clinical Trial Summaries > Treating Irritable Bowel Syndrome With a Food...

2003

AMERICAN JOURNAL OF GASTROENTEROLOGY
Volume 98, Issue 9 (Supplement 0), Pages S276

Jeanne A. Drisko, Bette Bischoff, Matthew A. Hall and Richard McCallum

Purpose:
In Irritable Bowel Syndrome (IBS), the gut-associated immune system may be upregulated by intolerances to food as a precipitating trigger.

Methods:
In this open label pilot study, we enrolled 20 patients with a history of diarrhea dominant IBS by Rome II criteria (15 women, ages 24–81) who had failed standard medical therapies in a tertiary care GI clinic. Baseline serum IgE and IgG food and mold panels and comprehensive digestive stool analysis (CDSA) to identify beneficial flora (e.g. Lactobacillus sp) and dysbiotic flora (e.g. Entamoeba histolytica) were performed. Breath-hydrogen testing and IBS Quality-of-Life (QOL) questionnaire were also obtained. During month 1, patients underwent food elimination diets based on the results of the food and mold panel. This was followed by controlled food challenge and rotation diet during months 2–5. Probiotics (Klaire’s Vital-10 powder) were introduced from months 2–5 with washout during month 6. Repeat serum IgG food and mold panels, CDSA, and IBS-QOL questionnaires were repeated at the beginning of month 6.

Results:
Abnormalities in breath-hydrogen testing were seen in 20% of the 20 study subjects at baseline. Imbalances of beneficial flora and dysbiotic flora were identified in 100% of subjects by CDSA. Nineteen subjects completed the trial. There was a trend to improvement of beneficial flora after probiotic treatment but no change in dysbiotic flora. Bowel flora did not correlate with symptom severity, QOL, or treatment outcome. Baseline abnormalities were identified on serum IgG food and mold panels in 100% of the study subjects with significant improvement after food elimination and rotation diet (p<0.05). Significant improvements were seen in stool frequency (p<0.05), pain (p<0.05), and IBS-QOL scores (p<0.0001) after intervention.

Conclusions:
1) These data demonstrate significant improvements in symptom complex and IBS-QOL after food elimination diets based on serum IgG and addition of probiotics

2) Individual IgG profiles and responses to food challenge are a fundamental aspect of this treatment theory

3) Small bowel bacterial overgrowth is present in a subpopulation (20%) of IBS patients

4) a double-blind trial seems warranted to pursue these compelling clinical results.

Affiliations:
University of Kansas, Kansas City, KS, USA.