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P230 Open label pilot study: an enzyme-rich malt extract (ERME™) for the treatment of chronic constipation
  1. Jordan Haworth1,2,
  2. Sarah Bloor1,2,
  3. Anthony Hobson1,2
  1. 1Functional Gut Clinic, Manchester, UK
  2. 2Functional Gut Diagnostics, Manchester, UK


Introduction The first line treatment for constipation is centred on fibre including increasing dietary fibre and/or fibre supplements. However, fermentable fibres can exacerbate other gastrointestinal (GI) symptoms, such as abdominal pain and bloating. ERME™, an enzyme-rich malt extract, is a food supplement which has been shown to reduce GI fermentation levels, but the effects of ERME™ on symptoms of constipation are unknown.

Methods 20 patients with chronic constipation were recruited for an open label, pilot study. Chronic constipation was determined by a Knowles-Eccersley-Scott Symptom (KESS) questionnaire score of ≥9. At baseline, patients completed a 1-week daily stool and symptom diary and fasted methane breath samples. Patients then took ERME™ (15ml, twice daily, with food) for 4-weeks, whilst continuing to complete a daily stool and symptom diary. After 4-weeks of ERME™, repeat KESS questionnaire and fasted methane breath samples were collected. Mean values were compared from baseline (Week 0) and Week 4 using paired sample t-tests.

Results 15 patients successfully completed the study. After 4-weeks of ERME™, the overall constipation (KESS) score significantly reduced (18.9 ±4.06 vs 12.8 ±6.06, p <0.001) and stool consistency significantly improved (2.6 ±0.90 vs 4.2 ±0.91, p = 0.003) from baseline. The number of weekly bowel movements (WBM) was not different (7.8 ±5.83 vs 9.6 ±4.01, p = 0.08), but subgroup analysis in patients (10/15) with ≤1 daily bowel movement showed a significant increase in WBM from baseline (4.6 ±2.3 vs 8.2 ±2.8, p = 0.006). Daily symptom scores (visual analog scale of 0–3) significantly reduced from Week 0 to Week 4 for abdominal pain (0.8 ±0.66 vs 0.5 ±0.62, p = 0.036) and bloating (1.0 ±0.82 vs 0.6 ±0.70, p = 0.002). 53.3% (8/15) of patients were excessive methane producers, but fasted breath methane levels were not different from baseline (p = 0.103). No adverse GI events were reported. Reasons for drop-out included unable to tolerate the taste of ERME™, antibiotic use, and loss to follow up.

Conclusion ERME™ is a safe and effective treatment for chronic constipation. This pilot study may be used to power larger, randomised controlled trials of ERME™ in patients with constipation.

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