Irritable bowel syndrome (IBS) is a highly prevalent chronic functional gastrointestinal disorder. The cardinal symptoms include abdominal pain, flatulence, bloating, and changes in bowel habits related to stool frequency and consistency, in the absence of detectable structural and biochemical abnormalities1,2. The prevalence is estimated at 5-10% among different ethnicities3. A low FODMAP diet is the most common dietary intervention with clinically proven benefits in symptom management and quality of life improvement of patients with Irritable Bowel Syndrome (IBS)4. Recently, a dietary digestive enzyme formulation (FODZYME©) claims similar efficacy in symptom management based on an ex-vivo study5. The study aims to examine the clinical efficacy of this formulation in managing IBS symptoms in patients who have previously clinically responded to a low FODMAP diet.
Provision of written informed consent.
Commitment to availability throughout the study period.
Patients who fulfilled the Rome IV criteria for IBS (IBS-D, IBS-M, IBS-U) participated in the two-arm clinical trial (ClinicalTrials.gov ID: NCT03997708) as responders to the Mediterranean Diet Adjusted to Low FODMAP (MED-LFD) (if their symptoms recurred -with IBS-SSS > 175- one year after their initial response to the dietary intervention).
Subjects randomized to the MED-LFD arm of the previous study who could not adhere to the dietary intervention.
Patients who did not take part in the aforementioned study
Patients who were randomized in the NICE group
Patients with IBS-SSS<175.
Single group
digestive enzymes
Dietary supplementA jar or single-dose sachets containing the digestive enzymes in the form of powder will be provided to each patient at the study entry. Patients will be instructed to use the powder formulation according to manufacturer instructions and according to the meals that they consume per day, for 1 month. Participants will be asked to return the jar or the single dose sachets with the remaining product to assess compliance either by weighting the jar or by counting the number of single-dose sachets returned. To reduce the placebo effect, patients will be misinformed that half will take a placebo formulation, randomly. Participants will be asked to return the jar or the single-dose sachets with the remaining product to assess compliance either by weighting the jar or by counting the number of single-dose sachets returned.
Changes in IBS-SSS from baseline to follow-up
Changes in IBS-SSS from baseline to follow-up in the group of patients that have responded to MED-LFD in the past. The IBS-SSS questionnaire consists of 5 specific questions6. Each of the five questions (pain severity, pain frequency, abdominal distension severity, bowel movement satisfaction, quality of life) ranges from a minimum score of 0 to a maximum score of 100, using a visual analog scale (VAS), with total scores ranging from 0 to 500.
Changes in the Gastrointestinal Symptom Rating Scale - IBS version (GSRS-IBS).
The GSRS questionnaire is validated in patients with IBS. GSRS-IBS consists of 13 items, designed to assess gastrointestinal symptoms specifically for IBS patients. Each item is rated based on a 7-point Likert scale (1. "No discomfort at all"; 2. "Minor discomfort"; 3. "Mild discomfort"; 4. "Moderate discomfort"; 5. "Moderately severe discomfort"; 6. "Severe discomfort"; 7. "Very severe discomfort"). The questionnaire has a total score and five subscales (pain, bloating, constipation, diarrhea, and satiety), calculated by summing all questions corresponding to each scale and dividing with the number of questions summed in each scale. Both total and subscale scores are ranging from 1 (no discomfort) to 7 (severe discomfort), with higher scores representing increased symptom burden.
Changes in SF-12.
SF-12 is a 12-item questionnaire used to assess generic health outcomes from the patient's perspective, covering two domains of health outcomes: physical functioning and mental health. The items are weighted and summed to provide physical and mental health scores. The two composite scores are computed using the scores on the questions that range from 0 to 100, with higher score indicating better QoL. SF-12 is validated also in the Greek population.
Changes in IBS-Qol.
The IBS-QoL assesses the degree to which IBS interfered with quality of life over the past 30 days10. It is a self-reported quality of life measure, which includes eight domains, such as dysphoria, interference with activity, body image, health worry, food avoidance, social relations, sexual and relationship issues. Each of them is rated based on a 5-point Likert scale (1. "Not at all"; 2." Slightly"; 3. "Moderately"; 4. "Quite a bit" 5. "Extremely/ A great deal").
Click on the lead sponsor to view all of their trials.
