Dietary Triggers of Gastrointestinal Symptoms in IBS Patients

NCT ID: NCT03664531

Last Updated: 2020-09-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

34 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-01-01

Study Completion Date

2022-02-28

Brief Summary

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This crossover randomized controlled trial will evaluate the effects of gluten and gluten combined with amylase-trypsin inhibitors (ATIs) on inducing intestinal and extra-intestinal symptoms in irritable bowel syndrome (IBS) patients. All participants will be put on a gluten-free diet and then challenged with muesli bars containing either purified gluten, gluten with ATIs, or nocebo.

Detailed Description

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Irritable bowel syndrome (IBS) is a heterogenous, common gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits. Many IBS patients report symptom relief on a gluten-free diet (GFD), but it is uncertain whether gluten is the true culprit. The gluten-containing grains wheat, rye, and barley all contain amylase-trypsin inhibitors (ATIs), and a GFD is virtually ATI-free.

This double-blinded crossover randomized controlled trial aims to determine which IBS patients are affected by pure gluten and which are affected by gluten combined with ATIs. IBS patients who respond to and have been on a GFD for 3+ weeks will be randomized to receive a dietary challenge of muesli bars containing either 1) pure gluten, 2) non-purified gluten (containing ATIs), 3) or nocebo for a week followed by a 14 day washout. This will be repeated until all participants have had each dietary challenge.

The study will evaluate the effects and potential mechanisms of purified and non-purified gluten on intestinal and extra-intestinal symptoms in IBS. It is likely that some IBS patients respond to gluten, while others respond to gluten combined with ATIs. Thus, this project may lead to better diagnosis and individualized dietary treatments for IBS.

Conditions

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Irritable Bowel Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Participants will be required to be on a gluten-free diet for a period of 3 weeks before starting the study. Participants will then be randomized to take muesli bars containing either purified gluten, non-purified gluten with amylase trypsin inhibitors, or nocebo for 1 week followed by 2 weeks of washout, and then repeated for the two remaining dietary challenges so that at the end all participants have been on all dietary challenges. At the beginning and end of each challenge period, participants will visit the clinic to be evaluated for changes in IBS symptoms.
Primary Study Purpose

OTHER

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
The statistician will also be masked from the treatments.

Study Groups

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Gluten, ATIs, nocebo

Participants will start on 1 week of muesli bars with purified gluten followed by 14 days washout. They will then take 1 week of muesli bars with non-purified gluten (containing ATIs) followed by 14 days of washout. Finally, they will have 1 week of nocebo muesli bars (with nothing).

Group Type EXPERIMENTAL

Purified gluten

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing purified gluten per day for 1 week, for a total of 10 g purified gluten per day.

Non-purified gluten (containing ATIs)

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing whole wheat flour with non-purified gluten per day for 1 week, for a total of 10 g non-purified gluten per day.

Nocebo

Intervention Type OTHER

1 gluten-free, ATI-free, low FODMAPs, vegan muesli bar per day for 1 week. This is a nocebo because we expect that participants will feel worse even though there is no potential irritant.

Gluten, nocebo, ATIs

Participants will start on 1 week of muesli bars with purified gluten followed by 14 days washout. They will then take 1 week of nocebo muesli bars (with nothing) followed by 14 days of washout. Finally, they will have 1 week of muesli bars with non-purified gluten (containing ATIs).

Group Type EXPERIMENTAL

Purified gluten

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing purified gluten per day for 1 week, for a total of 10 g purified gluten per day.

Non-purified gluten (containing ATIs)

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing whole wheat flour with non-purified gluten per day for 1 week, for a total of 10 g non-purified gluten per day.

Nocebo

Intervention Type OTHER

1 gluten-free, ATI-free, low FODMAPs, vegan muesli bar per day for 1 week. This is a nocebo because we expect that participants will feel worse even though there is no potential irritant.

ATIs, gluten, nocebo

Participants will start on 1 week of muesli bars with non-purified gluten (containing ATIs) followed by 14 days washout. They will then take 1 week of muesli bars with purified gluten followed by 14 days of washout. Finally, they will have 1 week of nocebo muesli bars (with nothing).

Group Type EXPERIMENTAL

Purified gluten

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing purified gluten per day for 1 week, for a total of 10 g purified gluten per day.

Non-purified gluten (containing ATIs)

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing whole wheat flour with non-purified gluten per day for 1 week, for a total of 10 g non-purified gluten per day.

Nocebo

Intervention Type OTHER

1 gluten-free, ATI-free, low FODMAPs, vegan muesli bar per day for 1 week. This is a nocebo because we expect that participants will feel worse even though there is no potential irritant.

ATIs, nocebo, gluten

Participants will start on 1 week of muesli bars with non-purified gluten (containing ATIs) followed by 14 days washout. They will then take 1 week of nocebo muesli bars (containing nothing) followed by 14 days of washout. Finally, they will have 1 week of muesli bars with purified gluten.

Group Type EXPERIMENTAL

Purified gluten

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing purified gluten per day for 1 week, for a total of 10 g purified gluten per day.

Non-purified gluten (containing ATIs)

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing whole wheat flour with non-purified gluten per day for 1 week, for a total of 10 g non-purified gluten per day.

Nocebo

Intervention Type OTHER

1 gluten-free, ATI-free, low FODMAPs, vegan muesli bar per day for 1 week. This is a nocebo because we expect that participants will feel worse even though there is no potential irritant.

Nocebo, ATIs, gluten

Participants will start on 1 week of nocebo muesli bars (with nothing) followed by 14 days washout. They will then take 1 week of muesli bars containing non-purified gluten (containing ATIs) followed by 14 days of washout. Finally, they will have 1 week of muesli bars with purified gluten.

Group Type EXPERIMENTAL

Purified gluten

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing purified gluten per day for 1 week, for a total of 10 g purified gluten per day.

Non-purified gluten (containing ATIs)

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing whole wheat flour with non-purified gluten per day for 1 week, for a total of 10 g non-purified gluten per day.

Nocebo

Intervention Type OTHER

1 gluten-free, ATI-free, low FODMAPs, vegan muesli bar per day for 1 week. This is a nocebo because we expect that participants will feel worse even though there is no potential irritant.

Nocebo, gluten, ATIs

Participants will start on 1 week of nocebo muesli bars (with nothing) followed by 14 days washout. They will then take 1 week of muesli bars with purified gluten followed by 14 days of washout. Finally, they will have 1 week of muesli bars with non-purified gluten (containing ATIs).

Group Type EXPERIMENTAL

Purified gluten

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing purified gluten per day for 1 week, for a total of 10 g purified gluten per day.

Non-purified gluten (containing ATIs)

Intervention Type OTHER

1 low FODMAPs, vegan muesli bar containing whole wheat flour with non-purified gluten per day for 1 week, for a total of 10 g non-purified gluten per day.

Nocebo

Intervention Type OTHER

1 gluten-free, ATI-free, low FODMAPs, vegan muesli bar per day for 1 week. This is a nocebo because we expect that participants will feel worse even though there is no potential irritant.

Interventions

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Purified gluten

1 low FODMAPs, vegan muesli bar containing purified gluten per day for 1 week, for a total of 10 g purified gluten per day.

Intervention Type OTHER

Non-purified gluten (containing ATIs)

1 low FODMAPs, vegan muesli bar containing whole wheat flour with non-purified gluten per day for 1 week, for a total of 10 g non-purified gluten per day.

Intervention Type OTHER

Nocebo

1 gluten-free, ATI-free, low FODMAPs, vegan muesli bar per day for 1 week. This is a nocebo because we expect that participants will feel worse even though there is no potential irritant.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* IBS diagnosis based on Rome IV criteria.
* Asymptomatic on a gluten-free diet (IBS-SSS score 0-74).
* Compliance with the study procedures (according to the investigator's own judgement).
* Signing the Study Informed Consent form.

Exclusion Criteria

* Concurrent systemic disease and/or laboratory abnormalities considered by investigators to be risky or that could interfere with data collection.
* Concurrent organic gastrointestinal disease (i.e. Celiac disease, Inflammatory Bowel Disease, peptic ulcer disease, etc.) other than benign polyps, diverticulosis, hemorrhoids, lipoma and melanosis coli.
* Major abdominal surgery with the exception of hernia repair, appendectomy, Caesarian section, tubal ligation, cholecystectomy, hysterectomy, and hemorrhoidectomy.
* History of active cancer in the last 5 years, other than skin basal cells cancer.
* Pregnant or breastfeeding women.
* Current use of antibiotics or antibiotic treatment within 1 months before the first visit.
* Consumption of probiotics within 1 month prior to the first visit.
* Use of non-authorized medications (see Unauthorized Medications section).
* Patients on a high fibre diet (\>35 g/day for males, \> 25 g/day for females), consuming high inulin containing foods (\>5 g/day), and/or consuming dietary fibre supplements (as assessed by dietary assessment questionnaire) in the 4 weeks prior to the first visit.
* Patients currently participating or having participated in a trial within the past month.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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McMaster University

OTHER

Sponsor Role lead

Responsible Party

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Premysl Bercik

MD, Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Premysl Bercik, MD

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Maria Ines Pinto-Sanchez, MD

Role: STUDY_DIRECTOR

McMaster University

Locations

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McMaster University Medical Centre

Hamilton, Ontario, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Caroline Seiler, BSc

Role: CONTACT

905-580-0325

Facility Contacts

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Caroline Seiler, BSc

Role: primary

905-580-0325

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Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

Diet in IBS

Identifier Type: -

Identifier Source: org_study_id

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