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  • Gunn, David; Abbas, Zainab; Harris, Hannah C; Major, Giles; Hoad, Caroline; Gowland, Penny; Marciani, Luca; Gill, Samantha K; Warren, Fred J; Rossi, Megan; Remes-Troche, Jose Maria; Whelan, Kevin; Spiller, Robin C

    Gut, 05/2022, Volume: 71, Issue: 5
    Journal Article

    Health-promoting dietary fibre including inulin often triggers gastrointestinal symptoms in patients with IBS, limiting their intake. Our aim was to test if coadministering psyllium with inulin would reduce gas production. A randomised, four-period, four-treatment, placebo-controlled, crossover trial in 19 patients with IBS. Subjects ingested a 500 mL test drink containing either inulin 20 g, psyllium 20 g, inulin 20 g+ psyllium 20 g or dextrose 20 g (placebo). Breath hydrogen was measured every 30 min with MRI scans hourly for 6 hours. Faecal samples from a subset of the patients with IBS were tested using an fermentation model. Primary endpoint was colonic gas assessed by MRI. Colonic gas rose steadily from 0 to 6 hours, with inulin causing the greatest rise, median (IQR) AUC 3145 (848-6502) mL·min. This was significantly reduced with inulin and psyllium coadministration to 618 (62-2345) mL·min (p=0.02), not significantly different from placebo. Colonic volumes AUC were significantly larger than placebo for both inulin (p=0.002) and inulin and psyllium coadministration (p=0.005). Breath hydrogen rose significantly from 120 min after inulin but not psyllium; coadministration of psyllium with inulin delayed and reduced the maximum increase, AUC from 7230 (3255-17910) ppm·hour to 1035 (360-4320) ppm·hour, p=0.007.Fermentation produced more gas with inulin than psyllium. Combining psyllium with inulin did not reduce gas production. Psyllium reduced inulin-related gas production in patients with IBS but does not directly inhibit fermentation. Whether coadministration with psyllium increases the tolerability of prebiotics in IBS warrants further study. NCT03265002.