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PubMed1987

Double blind study of ispaghula in irritable bowel syndrome.

A double blind placebo controlled trial of ispaghula husk in 80 patients with irritable bowel syndrome is reported. Global assessment judged treatment to be satisfactory in 82% of patients receiving ispaghula and 53% of the placebo group (p less than 0.02). Bowel habit was unchanged in the placebo group, while constipation significantly improved in patients taking ispaghula (p = 0.026). Transit time decreased significantly in those taking ispaghula compared with placebo (p = 0.001), especially in patients with initially high transit times. Abdominal pain and bloating improved in both groups, with no significant differences between ispaghula and placebo. Four of the eight withdrawals on ispaghula and 10 of the 15 withdrawals on placebo were because of treatment failure. Ispaghula significantly improves overall well being in patients with irritable bowel syndrome, and in those with constipation favourably affects bowel habit and transit time.

Adolescent↗

PubMed1987

Optimum dosage of ispaghula husk in patients with irritable bowel syndrome: correlation of symptom relief with whole gut transit time and stool weight.

To determine the optimum dose of ispaghula husk in patients with irritable bowel syndrome (IBS) and to assess the correlation, if any between the relief in patients' symptoms and the whole gut transit time, and the increase in stool weight, a two part study was carried out. In part 1, 14 male patients were given ispaghula husk in increasing doses of 10 g, 20 g, and 30 g a day for a duration of 17 days each (14 days of study period + three days of stool collection). Ten patients completed the trial. The symptom score improved significantly with all the three doses of ispaghula. Both 20 g and 30 g doses of ispaghula were superior to the 10 g dose but there was no significant difference between the 20 g and 30 g doses. There was a significant (p less than 0.001) increase in the daily stool weight with 10 g dose of fibre with further significant increases with the 20 g and 30 g doses. A positive correlation was seen between the improvement in the symptom score and the increase in stool weight with the 10 g dose of ispaghula but not with the 20 g and 30 g doses. Whole gut transit time remained fairly constant throughout the study period and there was no relationship with either the dose of ispaghula, the alteration in stool weight, or the improvement in the patients symptoms. Ten patients completed part 2 of the study in which ispaghula husk was given in the same dose (10 g, 20 g, and 30 g) but in a random order and with a "washout" period of one week between individual doses. Again all the three doses of ispaghula produced a significant improvement in the symptoms; 20 g and 30 g doses were equally effective and both were significantly superior to the 10 g dose. Assessed individually, all the three symptoms improved significantly; improvement in constipation and pain abdomen was more pronounced than diarrhoea. It is concluded that the optimum dose of ispaghula husk in irritable bowel syndrome is 20 g per day. There is some correlation between the increase in stool weight and the improvement in symptom score but the whole gut transit time remains unchanged despite alterations in stool weight and patients' symptoms.

Adult↗

PubMed1991

Colonic fermentation of dietary fibre to short chain fatty acids in patients with adenomatous polyps and colonic cancer.

Short chain (C2-C6) fatty acids are produced in the colon through bacterial fermentation of mainly dietary fibre. Butyrate (C4) possesses antineoplastic effects on human colon carcinoma cells, and epidemiological studies indicate that high fibre diets may reduce the incidence of colorectal cancer. The role of dietary fibre during colorectal carcinogenesis might therefore be related to its fermentation to butyrate. Faecal concentrations of total short chain fatty acids and concentrations and ratios of the individual C2-C6 fatty acids did not differ between 16 healthy controls, 17 patients with colonic adenomas, and 17 patients with colonic cancer. Comparison of the molar production velocities (mmol/l.hour) of total and individual short chain fatty acids from glucose, ispagula, wheat bran, and albumin in six and 24 hour faecal incubations showed no differences. The ratio of butyrate production to total short chain fatty acid production from fibre, however, was reduced in patients with colonic cancer and adenomas compared with healthy controls (ispagula, six hours: 6.4, 7.6, and 11.5% respectively, p = 0.005 and 24 hour: 9.1, 9.9, and 15.4%, p = 0.002; wheat bran, six hours: 9.9, 10.2, and 14.7% respectively, p = 0.06 and 24 hours: 15.1, 16.8, and 21.0%, p = 0.01). It may be that the low ratios of colonic butyrate formation combined with low fibre diets increase the risk of colonic neoplasia.

Adenoma↗

PubMed1992

Comparison of the effects of ispaghula and wheat bran on rat caecal and colonic fermentation.

The effects of ispaghula and wheat bran on the contents of the caecum and proximal and distal colon of the rat were investigated to identify any differences that might account for their effects on colonic motility. Rats fed diets supplemented with 5% ispaghula and 10% wheat bran for 28 days were killed and the contents of the gut collected. Caecal and colonic content wet and dry weight and short chain fatty acid (SCFA) content were measured. In additional in vitro fermentations in batch cultures of mixed rat caecal bacteria with ispaghula and bran, SCFA production was monitored over 24 hours. Both ispaghula and wheat bran increased faecal weight but ispaghula was more effective. Ispaghula resulted in greater and more liquid contents, with a characteristic pattern of SCFA production (higher propionic acid) maintained throughout the colon. In contrast, wheat bran affected only the caecum and faeces. SCFA content and wet and dry weight in the proximal and distal colon were unaffected by wheat bran. Caecal butyrate was characteristically higher in wheat bran fed rats but ispaghula produced higher butyrate in the distal colon. In contrast, ispaghula seemed to be fermented more quickly in vitro than wheat bran. Thus, wheat bran has a portion that is rapidly fermented and an inert residue that may stimulate motility. Ispaghula seems to be fermented throughout the colon but maintains a high water content which dilutes the luminal contents.

Animals↗

PubMed1994

Digestibility and bulking effect of ispaghula husks in healthy humans.

The digestibility of ispaghula, a mucilage from Plantago ovata composed mainly of arabinoxylans, and its faecal bulking effect were studied in seven healthy volunteers who ingested a low fibre controlled diet plus either placebo or 18 g/day of ispaghula for two 15 day periods. Whole gut transit time and gas excretion in breath and flatus were not different during the periods of ispaghula and placebo ingestion. Faecal wet and dry weights rose significantly, however, during ispaghula ingestion. Faecal short chain fatty acid concentrations and the molar proportions of propionic and acetic acids also increased. Most of the ispaghula had reached the caecum four hours after ingestion in an intact highly polymerised form. During ispaghula ingestion, the increase in the faecal output of neutral sugars was accounted for by the faecal excretion of arabinose and xylose in an intact highly polymerised form; the apparent digestibilities of these sugars were 24 (11) and 53% (6) respectively (mean (SEM)). In conclusion, ispaghula is more resistant to fermentation than previously reported in humans, and its bulking effect largely results from intact material.

Acetates↗

PubMed1991

Serum bile acids in relation to disease activity and intake of dietary fibers in juvenile ulcerative colitis.

Serum concentrations of primary bile acids were determined at different disease activities in juvenile ulcerative colitis and in healthy age-matched controls. In patients with ulcerative colitis in clinical remission, serum levels of bile acids were also studied after long-term intake (6 months) of dietary fibers (wheat fiber and ispaghula, respectively) in a double-blind randomized cross-over study. Blood samples were taken in the morning after an overnight fasting and for 4 h postprandially after a standardized test meal. Determinations of bile acids were made by radioimmunoassays. Patients with total colitis in the active phase had significantly higher serum levels of cholic and chenodeoxycholic acids 4 h postprandially compared with control children. After long-term intake of ispaghula, significantly higher (although not different from controls) serum levels of cholic acid were found 2 and 3 h postprandially, whereas wheat fibers did not affect serum bile acid concentrations. These results may suggest an increased absorption of unconjugated bile acids in the diseased colon and a minimal influence of dietary fibers on serum bile acid concentrations.

Adolescent↗

PubMedDate not supplied

Colonic fermentation of ispaghula, wheat bran, glucose, and albumin to short-chain fatty acids and ammonia evaluated in vitro in 50 subjects.

The production of short-chain fatty acids and ammonia was measured in 16.6% fecal homogenates from 50 subjects incubated at 37 degrees C for 6 and 24 hours. All 50 homogenates produced ammonia and short-chain fatty acids of any chain length (C2-C5). Incubation for 24 hours with dietary fiber (ispaghula husk or wheat bran), albumin, or glucose (10 mg/mL) increased the short-chain fatty acid production (43.6 +/- 2.8, 45.4 +/- 2.0, 60.3 +/- 3.2, and 65.8 +/- 3.1 mmol/L, respectively) compared with controls (21.4 +/- 1.3 mmol/L). The degradation of different substrates was associated with the production of different amounts of ammonia and short-chain fatty acids. Ispaghula, wheat bran, albumin, and glucose were fermented to acetate (> 2 mmol/L; 24-hour incubations) in 86%, 96%, 98%, and 98% of the homogenates, to propionate in 80%, 76%, 100%, and 68%, and to butyrate in 32%, 94%, 88%, and 54% of the homogenates, respectively. Isobutyrate, valerate, and isovalerate were produced from albumin in all (100%) of the homogenates, but only in 2 to 4% of the homogenates incubated with ispaghula or glucose. Ammonia was always (100%) produced after the addition of albumin and always (98%) consumed (assimilated) when glucose was fermented. Surgery (sigmoid or right- or left-sided colonic resection) did not change the pattern of ammonia and short-chain fatty acid production from these substrates. This study suggests that the different colonic flora from a large number of subjects share general biochemical characteristics, which metabolize different substrates to specific patterns of ammonia and short-chain fatty acids.

Adult↗

PubMed1983

A crossover comparative study with two bulk laxatives.

Twenty elderly in-patients suffering from severe constipation were treated once daily for 2 weeks with each of two bulk laxatives. The preparations were allocated randomly as the first and second preparation. Agiolax, the new preparation, contained 15 mg senna glucosides, the old preparation, Lunelax comp., contained 25 mg senna glucoside A + B per dose. Both preparations worked well and no side-effects were seen.

Aged↗

PubMed2000

The long-term safety and tolerability of ispaghula husk.

The safety and tolerability of ispaghula husk, which can now be used as an adjunct to diet for the treatment of mild-to-moderate hypercholesterolaemia, was assessed in 93 healthy subjects over a 52-week period. The study looked at the nutritional, biochemical, and haematological effects of ispaghula. Over the study period there were small but statistically significant changes in some measurements of minerals and vitamin levels, and in some haematological and biochemical parameters. However, none of these were of clinical significance, with the possible exception of changes in vitamin B12 levels. A daily dose of 10.5 g ispaghula was well tolerated and the majority of adverse events recorded were minor, of short duration and either unrelated or possibly related to the study treatment. The results suggest that ispaghula husk can be used with confidence for the long-term treatment of mild-to-moderate hypercholesterolaemia.

Adult↗

PubMed2000

Dietary fibre, physicochemical properties and their relationship to health.

Dietary carbohydrates that escape digestion and absorption in the small intestine include non-digestible oligosaccharides (carbohydrates with a degree of polymerisation between three and ten), resistant starch and non-starch polysaccharides. The physiological effects of this heterogeneous mixture of substrates are partly predictable on the basis of their physicochemical properties. Monosaccharide composition and chain conformation influence the rate and extent of fermentation. Water-holding capacity affects stool weight and intestinal transit time. Viscous polysaccharides can cause delayed gastric emptying and slower transit through the small bowel, resulting in the reduced rate of nutrient absorption. Polysaccharides with large hydrophobic surface areas have potentially important roles in the binding of bile acids, carcinogens and mutagens. Ispaghula is capable of binding bile acids through a large number of weak binding sites on the polysaccharide structure, and having greatest effect on the potentially more harmful secondary bile acids deoxycholic acid and lithocholic acid.

Adsorption↗

PubMed1998

Determinants of the bronchial response to high molecular weight occupational agents in a dry aerosol form.

In occupational challenge tests with isocyanate vapours, bronchial responsiveness is determined by the total dose rather than the concentration or duration of exposure. Whether the same applies for high molecular weight (HMW) agents in powder form is unknown. The aim of this study was to determine whether the total dose of HMW agents in powder form is responsible for the immediate reaction documented in specific challenge tests. Included in the study were nine subjects (seven males and two females) with a diagnosis of occupational asthma proved by specific challenge tests carried out on a preliminary visit. Two challenge tests (using a closed-circuit exposure chamber) were performed at an interval of 2 weeks; the concentrations administered in a random order on these two visits were half and double the one that had caused a 20% fall in forced expiratory volume in one second (FEV1) on a preliminary visit. The duration of exposure was adjusted until a significant fall in FEV1 (target of 20%) occurred. The two concentrations obtained were significantly different, by 2.07+/-0.36-fold (SD). The observed durations of exposure leading to a 20% fall in FEV1 on the two visits also differed significantly by 0.46+/-0.32-fold. Consequently, the cumulative efficient doses were not significantly different between the two visits: 12+/-5.4 and 9+/-5 mg x mL(-1) x min(-1), respectively. The corresponding cumulative dose ratio was 0.96+/-0.61. The expected duration of exposure (10.8+/-24 min) was not significantly different from the observed duration (5.4+/-9 min). The mean and 95% confidence interval for the difference in concentration between the two visits was 1.83-fold (1.48-2.21). In conclusion, the total dose rather than the concentration or duration of exposure per se determines bronchial responsiveness to high molecular weight agents in powder form.

Adult↗

PubMed1998

A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation.

An open, multi-centre study in general practice compared with efficacy, speed of action and acceptability of ispaghula husk (Fybogel Orange, Reckitt & Colman Products, UK), lactulose and other laxatives in the treatment of patients with simple constipation. A total of 65 GPs recruited 394 patients, of whom 224 (56.9%) were assigned to treatment with ispaghula and 170 (43.1%) to other laxatives (mainly lactulose) for up to four weeks. Thirteen patients withdrew before treatment started, so that 381 entered the study. Patients were assessed by their GP before entry and after two and four weeks of treatment. Patients also kept daily records of their bowel movements. After four weeks' treatment, ispaghula husk was assessed by the GPs to be superior to the other treatments in improving bowel function and in overall effectiveness, palatability and acceptability. Patients' reports of time to first bowel movement showed little difference between the treatments. Over 60% of patients in each treatment group passed a first motion within 24 hours, and over 80% within 36 hours. Ispaghula husk produced a higher percentage of normal, well-formed stools and fewer hard stools than other laxatives. Incidences of soiling, diarrhoea and abdominal pain were lower in the group receiving ispaghula husk. Overall, ispaghula husk was an effective treatment for simple constipation, and was associated with better stool consistency and a lower incidence of adverse events compared with lactulose or with other laxatives.

Adult↗

PubMed1967