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We read the randomised controlled trial (RCT) by Zhou et al. 1 The authors recruited a highly selected group of patients with increased intestinal permeability and postinfection IBS with diarrhoea (IBS-D), defined by an unconfirmed enteric infection in the 12 months prior to symptom onset, and randomised them to 8 weeks of treatment with either glutamine or placebo. The population screened also had other curious features. For example, only four had rapid orocaecal transit on lactulose hydrogen breath testing, erroneously described as small intestinal bacterial overgrowth. This appears low, compared with other studies examining this issue in patients with IBS.
There are other minor issues with the trial conduct and analysis. First, compliance was checked by telephone calls, not a particularly robust method. Second, the efficacy analysis was per-protocol, rather than intention-to-treat, and minimal information on dropouts …
Contributors ACF and PRG conceived and drafted the letter. Both authors have approved the final draft of the manuscript.
Competing interests PRG: His institution has served as an advisory board member for Allergan and Danone. He has received research grants for investigator-driven studies from the A2 Milk Company. His department financially benefits from the sales of a digital application and booklets on the low FODMAP diet. He has published an educational/recipe book on diet in IBS.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.