Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies

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

doi:10.1136/gutjnl-2021-324784

Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies

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

^*Corresponding author for this work

Nutritional Sciences

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Abstract

Objective 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. Design 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 in vitro fermentation model. Primary endpoint was colonic gas assessed by MRI. Results Colonic gas rose steadily from 0 to 6 hours, with inulin causing the greatest rise, median (IQR) AUC_{(0-360 min)} 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_{(0-360 min)} 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_{(0-360 min)} from 7230 (3255-17910) ppm·hour to 1035 (360-4320) ppm·hour, p=0.007. Fermentation in vitro produced more gas with inulin than psyllium. Combining psyllium with inulin did not reduce gas production. Conclusions 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.

Original language	English
Article number	324784
Journal	Gut
DOIs	https://doi.org/10.1136/gutjnl-2021-324784
Publication status	Accepted/In press - 8 Jul 2021

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Main document unmarked Effect of fibre in IBS in vivo and in vitro 060721Accepted author manuscript, 531 KB

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@article{dd5b7fbb7e654b9d9985238427de5277,

title = "Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies",

abstract = "Objective 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. Design 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 in vitro fermentation model. Primary endpoint was colonic gas assessed by MRI. Results Colonic gas rose steadily from 0 to 6 hours, with inulin causing the greatest rise, median (IQR) AUC(0-360 min) 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(0-360 min) 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(0-360 min) from 7230 (3255-17910) ppm·hour to 1035 (360-4320) ppm·hour, p=0.007. Fermentation in vitro produced more gas with inulin than psyllium. Combining psyllium with inulin did not reduce gas production. Conclusions 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.",

author = "David Gunn and Zainab Abbas and Harris, {Hannah C.} and Giles Major and Caroline Hoad and Penny Gowland and Luca Marciani and Gill, {Samantha K.} and Warren, {Fred J.} and Megan Rossi and Remes-Troche, {Jose Maria} and Kevin Whelan and Spiller, {Robin C.}",

year = "2021",

month = jul,

day = "8",

doi = "10.1136/gutjnl-2021-324784",

language = "English",

journal = "Gut",

issn = "0017-5749",

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}

TY - JOUR

T1 - Psyllium reduces inulin-induced colonic gas production in IBS

T2 - MRI and in vitro fermentation studies

AU - Gunn, David

AU - Abbas, Zainab

AU - Harris, Hannah C.

AU - Major, Giles

AU - Hoad, Caroline

AU - Gowland, Penny

AU - Marciani, Luca

AU - Gill, Samantha K.

AU - Warren, Fred J.

AU - Rossi, Megan

AU - Remes-Troche, Jose Maria

AU - Whelan, Kevin

AU - Spiller, Robin C.

PY - 2021/7/8

Y1 - 2021/7/8

N2 - Objective 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. Design 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 in vitro fermentation model. Primary endpoint was colonic gas assessed by MRI. Results Colonic gas rose steadily from 0 to 6 hours, with inulin causing the greatest rise, median (IQR) AUC(0-360 min) 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(0-360 min) 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(0-360 min) from 7230 (3255-17910) ppm·hour to 1035 (360-4320) ppm·hour, p=0.007. Fermentation in vitro produced more gas with inulin than psyllium. Combining psyllium with inulin did not reduce gas production. Conclusions 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.

AB - Objective 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. Design 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 in vitro fermentation model. Primary endpoint was colonic gas assessed by MRI. Results Colonic gas rose steadily from 0 to 6 hours, with inulin causing the greatest rise, median (IQR) AUC(0-360 min) 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(0-360 min) 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(0-360 min) from 7230 (3255-17910) ppm·hour to 1035 (360-4320) ppm·hour, p=0.007. Fermentation in vitro produced more gas with inulin than psyllium. Combining psyllium with inulin did not reduce gas production. Conclusions 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.

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U2 - 10.1136/gutjnl-2021-324784

DO - 10.1136/gutjnl-2021-324784

M3 - Article

AN - SCOPUS:85112306854

SN - 0017-5749

JO - Gut

JF - Gut

M1 - 324784

ER -

Psyllium reduces inulin-induced colonic gas production in IBS: MRI and in vitro fermentation studies

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