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IBS management: the complex role of dietary fibres

Presented by
Dr Jose Maria Remes-Troche, Veracruzana University, Mexico
DDW 2023
Recent research has underscored the complex influence of varied dietary fibre types on irritable bowel syndrome (IBS), particularly noting their effects on gut transit time and microbiota, notwithstanding certain side effects, such as colonic gas production. A novel trial underpins the differential impact these fibres can have on IBS symptoms and gut microbiota.

The investigation, presented by Dr Jose Maria Remes-Troche (Veracruzana University, Mexico), was a double-blind, placebo-controlled clinical trial (NCT03803319) conducted across Mexico and the United Kingdom [1]. It evaluated the effect of co-administering distinct types of dietary fibres on IBS patients. Participants were given either a placebo, a combined dose of extracted fibres (inulin and psyllium), or native fibres (nopal) twice daily over 8 weeks. The trial's main objective was to measure the impact of these interventions on the patients' gut microbiota and IBS symptoms. Secondary objectives included evaluating stool consistency, gut transit times, and microbial metabolites.

A total of 133 patients were included who were randomised to inulin/psyllium (n=47), nopal (n=44), or placebo (n=42). The results revealed no significant differences in the relief of IBS symptoms assessed by the Global Symptom Question across the 3 groups (P=0.724). However, the incidence and severity of constipation and hard stools were notably reduced in the inulin/psyllium (4.5%) compared with nopal (15.1%, P=0.026) and placebo (15.6%, P=0.02).

Additionally, the inulin/psyllium group exhibited a decreased Shannon diversity index (4.0) in contrast to both nopal (4.4, P=0.024) and placebo (4.5, P=0.016). In particular, inulin/psyllium resulted in a lower abundance of Ruminococcus (P=0.001), Dorea (P=0.016), and Coprococcus (P=0.011) and higher Bifidobacteria (P=0.055). These changes were not associated with short-chain fatty acid production alterations, suggesting a unique effect on the gut microbiome's composition.

Overall, the co-administration of inulin and psyllium was shown to mitigate constipation without exacerbating IBS symptoms, despite not leading to overall clinical improvements. These findings suggest the potential for personalised, fibre-based interventions in IBS management based on individual symptom profiles and microbiota configurations.

  1. Remes-Troche JM, et al. Fiber co-administration and impact on symptoms, gut transit time and gut microbiome in irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. Lecture 1248, DDW 2023, 6–9 May, Chicago, IL, USA.


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