title: A rapid, simple questionnaire to assess gastrointestinal symptoms after oral ferrous sulphate supplementation.
abstract: BACKGROUND
  Oral iron supplementation is often associated with rapid onset of gastrointestinal side-effects. The aim of this study was to develop and trial a short, simple questionnaire to capture these early side-effects and to determine which symptoms are more discriminating.
  
  
  METHODS
  The study was a double-blind placebo-controlled randomized parallel trial with one week treatment followed by one week wash-out. Subjects were randomized into two treatment groups (n = 10/group) to receive either ferrous sulphate (200 mg capsules containing 65 mg of iron) or placebo, both to be taken at mealtimes twice daily during the treatment period. Subjects completed the questionnaires daily for 14 days. The questionnaire included gastrointestinal symptoms commonly reported to be associated with the oral intake of ferrous iron salts (i.e. nausea, vomiting, heartburn, abdominal pain, diarrhoea, and constipation).
  
  
  RESULTS
  Seventy five per cent of participants reporting the presence of one or more symptoms in the first week of the study were in the ferrous sulphate group. In the second week of the study (i.e. wash-out), 67% of the participants reporting one or more symptom(s) were in the ferrous sulphate group. In the first week of the study (treatment) the number of symptoms reported by participants in the ferrous sulphate group (mean ± SEM = 6.7 ± 1.7) was significantly higher than that for participants in the placebo group (1.2 ± 0.5) (p = 0.01). In the second week of the study (wash-out) the number of symptoms reported by participants in the ferrous sulphate group (4.6 ± 2.0) appeared higher than for participants in the placebo group (1.0 ± 0.7) although this did not reach significance (p = 0.12). Events for which the gastrointestinal symptom questionnaire was most discriminatory between ferrous sulphate and placebo groups were: heartburn, abdominal pain and the presence of black stools (all p ≤ 0.03).
  
  
  CONCLUSIONS
  A tool for the detection of commonly-occurring side effects should not require large study numbers to be effective. With just 10 subjects per group (iron or placebo), this simple questionnaire measures gastrointestinal side-effects associated with oral iron (ferrous sulphate) supplementation, and would be appropriate for use in intervention studies or clinical trials.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT02146053 (21/05/2014).
authors.affiliation: MRC Human Nutrition Research, Elsie Widdowson Laboratory, CB1 9NL Cambridge, UK. dora.pereira@mrc-hnr.cam.ac.uk.
authors.forename: Dora I A
authors.initials: DI
authors.lastname: Pereira
authors.forename: Susana S
authors.initials: SS
authors.lastname: Couto Irving
authors.forename: Miranda C E
authors.initials: MC
authors.lastname: Lomer
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Powell
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced / Q000175:diagnosis*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy*; D003248:Constipation / Q000139:chemically induced / Q000175:diagnosis*; D003967:Diarrhea / Q000139:chemically induced / Q000175:diagnosis*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005296:Ferrous Compounds / Q000009:adverse effects*; D006356:Heartburn / Q000139:chemically induced / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000139:chemically induced / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D005296:Ferrous Compounds; C020748:ferrous sulfate