Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, with a prevalence of 5-15% in the Western population. It is characterised by recurrent abdominal pain or discomfort associated with changes in bowel habits, without the presence of a clear organic cause. However, several factors have been hypothesized to play a role, including e.g. disturbances in microbiota composition and activity, low-grade inflammation, and an altered intestinal barrier function motility and intestinal sensitivity. In addition, two-thirds of the IBS-patients considered their symptoms to be triggered by food intake or specific food items among which wheat consumption is often mentioned as a potential cause of symptoms in IBS patients. It has also been suggested that replacing modern Bread-Wheat based foods by products derived from “ancient” wheats such as Spelt and Emmer, has benefits for IBS patient, in terms of relief of symptoms. In addition to gluten, the presence of FODMAPs (rapidly fermentable undigested carbohydrates and fibers) and amylase trypsin inhibitors (ATI’s) both also present in wheat, have also been suggested as potential provocative factors for IBS-related symptoms.

Therefore, we aim to perform a randomized controlled cross-over study to assess the effects of consuming bread made from modern Bread Wheat, Emmer, and/or Spelt on symptoms and general wellbeing, as well as on intestinal permeability, immune function and the intestinal microbiota in patients with IBS. IBS patients will be recruited from a large cohort of well-characterised IBS patients that has been established at Maastricht University Medical Centre, Maastricht, The Netherlands and via the outpatient clinic as well as local newspapers. At several time points faecal samples will be collected to analyse the microbiota and gut metabolism. Gastrointestinal symptoms will be monitored with different questionnaires to measure the patient-reported impact of bread consumption of fully known composition on (abdominal) well-being. Breath samples will be analysed to identify volatile organic compounds reflecting host and microbial metabolism. Blood samples will be used to analyse immune markers, whereas intestinal permeability will be assessed by the multi-sugar test.

Research team of Maastricht University Medical Centre will be lead this study. Coordination by Prof. Dr. F. Brouns, Maastricht University; Faculty of Human Biology. Prinicipal Investigator: D.M.A.E. Jonkers, Maastricht University; Dept. of Internal Medicine, Division of Gastroenterology and Hepatology. PhD-candidate: A.E.P. van Rooy, Maastricht University; Dept. of Internal Medicine, Division of Gastroenterology and Hepatology.