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      Long-term safety and efficacy study of a medical device containing xyloglucan, pea protein reticulated with tannins and xylo-oligosaccharides, in patients with diarrhoea-predominant irritable bowel syndrome

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          Abstract

          Background:

          Irritable bowel syndrome with diarrhoea (IBS-D) is a frequent problem associated with a significant socioeconomic implication. Increased gut permeability is an important pathophysiological mechanism. A medical device containing xyloglucan (XG), pea protein and tannins (PPT) from grape-seed extract, and xylo-oligosaccharides (XOS) has proven restoration of intestinal barrier function. Our objective was to evaluate the efficacy and safety of treatment with the medical device XG + PPT + XOS (XG-PPT-XOS) in adult patients with IBS-D in a clinical setting for 6 months.

          Material and methods:

          This was a multicentre, open-label, prospective, observational study conducted to evaluate long-term safety and efficacy of XG-PPT-XOS. IBS-D adult patients (Rome IV criteria) were included and received two tablets twice daily for 6 months. IBS Symptom Severity Score (IBS-SSS) and bowel habit were registered at baseline and monthly, until the end of follow up. Efficacy was evaluated by comparison of mean scores at each time point.

          Results:

          50 patients were included, of which 19 completed the 6 months. IBS-SSS score decreased from 312.2 ± 82.2 to 213.6 ± 109.9 ( p < 0.0001) at 1 month and 192.0 ± 108.9 at the last visit completed; diarrhoea score decreased from 45.6 ± 17.9 to 25.7 ± 17.7 and 25.3 ± 17.2 at 1 month and at the last visit completed, respectively. Pain score decreased from 107.8 ± 49.9 at baseline to 73.2 ± 57.3 ( p < 0.0001) at 1 month and bloating score from 56.4 ± 28.8 at baseline to 42.8 ± 32.6 ( p < 0.001) at 1 month, reaching 62.4 ± 56.0 and 40.4 ± 34.3, respectively, at the last visit completed. Adverse effects were mild and mostly not related to treatment.

          Conclusion:

          Treating IBS-D patients with XG-PPT-XOS is effective and safe in the long term within a clinical setting, improving all IBS-D symptoms from the first month of treatment and showing a sustained response over the term of therapy.

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          Most cited references20

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          The Brain-Gut-Microbiome Axis

          Preclinical and clinical studies have shown bidirectional interactions within the brain-gut-microbiome axis. Gut microbes communicate to the central nervous system through at least 3 parallel and interacting channels involving nervous, endocrine, and immune signaling mechanisms. The brain can affect the community structure and function of the gut microbiota through the autonomic nervous system, by modulating regional gut motility, intestinal transit and secretion, and gut permeability, and potentially through the luminal secretion of hormones that directly modulate microbial gene expression. A systems biological model is proposed that posits circular communication loops amid the brain, gut, and gut microbiome, and in which perturbation at any level can propagate dysregulation throughout the circuit. A series of largely preclinical observations implicates alterations in brain-gut-microbiome communication in the pathogenesis and pathophysiology of irritable bowel syndrome, obesity, and several psychiatric and neurologic disorders. Continued research holds the promise of identifying novel therapeutic targets and developing treatment strategies to address some of the most debilitating, costly, and poorly understood diseases.
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            The intestinal epithelial barrier: a therapeutic target?

            A fundamental function of the intestinal epithelium is to act as a barrier that limits interactions between luminal contents such as the intestinal microbiota, the underlying immune system and the remainder of the body, while supporting vectorial transport of nutrients, water and waste products. Epithelial
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              Irritable Bowel Syndrome.

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                Author and article information

                Contributors
                Journal
                Therap Adv Gastroenterol
                Therap Adv Gastroenterol
                TAG
                sptag
                Therapeutic Advances in Gastroenterology
                SAGE Publications (Sage UK: London, England )
                1756-283X
                1756-2848
                30 May 2021
                2021
                : 14
                : 17562848211020570
                Affiliations
                [1-17562848211020570]Servicio de Aparato Digestivo, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
                [2-17562848211020570]Servicio de Aparato Digestivo, Hospital 12 de Octubre, Madrid, Spain
                [3-17562848211020570]Servicio de Aparato Digestivo, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
                [4-17562848211020570]Servicio de Aparato Digestivo, Universidad de Sevilla, Seville, Spain
                [5-17562848211020570]Servicio de Aparato Digestivo, Hospital Reina Sofía Córdoba, Spain
                [6-17562848211020570]Servicio de Aparato Digestivo, Hospital Ramon y Cajal, Madrid, Spain
                [7-17562848211020570]Servicio de Aparato Digestivo, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
                [8-17562848211020570]Servicio de Aparato Digestivo, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria San Carlos (IdISSC), Ciudad Universitaria s/n, Madrid 28040, Spain
                Author notes
                Author information
                https://orcid.org/0000-0002-5060-7105
                Article
                10.1177_17562848211020570
                10.1177/17562848211020570
                8170336
                f9a65076-ee42-457b-ab7f-10a8ad7b6c40
                © The Author(s), 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 2 November 2020
                : 6 May 2021
                Categories
                Original Research
                Custom metadata
                January-December 2021
                ts1

                diarrhoea,gut permeability,irritable bowel syndrome,mucoprotectants,xyloglucan,xylo-oligosaccharides

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