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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 …
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