Increased serum free tryptophan in patients with diarrhea-predominant irritable bowel syndrome.
Irregularities of serotonin function in irritable bowel syndrome (IBS) may be due to changes in the metabolism of the serotonin precursor l-tryptophan. Dietary alteration of tryptophan intake may impact upon the mood and bowel symptoms of IBS. We hypothesized that diarrhea-predominant irritable bowel syndrome (d-IBS) patients would exhibit an increase in plasma tryptophan due to alterations in tryptophan metabolism. We also hypothesized that a diet low in tryptophan would reverse this change and reduce symptoms. Thirteen patients with d-IBS had fasting serum free and total tryptophan, large neutral amino acids, and 6 kynurenine metabolites measured before and after 2 weeks of a strict dairy-free diet. Baseline tryptophan parameters were compared with an age- and sex-matched control group. Changes in the specific tryptophan parameters before and after dairy-free diet were correlated with symptoms of IBS and mood. Compared with the control group, d-IBS patients at baseline exhibited significantly higher free serum tryptophan (10.5 ± 4.35 vs 4.75 ± 2.43 μmol/L [means ± standard deviation], P = .006) and significantly lower tryptophan dioxygenase and total tryptophan oxidation as measured by the kynurenine to free tryptophan and total kynurenines to free tryptophan ratios (23.37 ± 10.12 vs 55.33 ± 16.02, P < .001 and 49.34 ± 17.84 vs 258.46 ± 98.67, P < .001, respectively). Dairy-free diet did not modulate metabolites of the kynurenine pathway or symptoms. Tryptophan metabolism along the kynurenine pathway is inhibited in d-IBS, and a dairy-free diet does not alter this. Our findings are consistent with possible enhanced serotonin activity in d-IBS.
Academic Unit of Psychiatry, University of Bristol, Cotham House, Cotham Hill, BS6 6JL Bristol, UK. david.christmas@bristol.ac.uk
David M
DM
Christmas
Abdulla A-B
AA
Badawy
Dana
D
Hince
Simon J C
SJ
Davies
Christopher
C
Probert
Tom
T
Creed
John
J
Smithson
Muhammad
M
Afzal
David J
DJ
Nutt
John P
JP
Potokar
D000328:Adult; D000339:Affect; D021542:Amino Acids, Neutral / Q000097:blood; D016022:Case-Control Studies; D003611:Dairy Products; D003967:Diarrhea / Q000097:blood*; D004032:Diet; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000097:blood* / Q000523:psychology; D007737:Kynurenine / Q000097:blood; D008297:Male; D008875:Middle Aged; D010084:Oxidation-Reduction; D012701:Serotonin / Q000378:metabolism*; D014364:Tryptophan / Q000008:administration & dosage / Q000097:blood*; D014366:Tryptophan Oxygenase / Q000097:blood*
D021542:Amino Acids, Neutral; D012701:Serotonin; D007737:Kynurenine; D014364:Tryptophan; D014366:Tryptophan Oxygenase