NASHVILLE — A commercially available enzyme combination supplement targeting fermentable oligo-, di-, and monosaccharides, and polyols (FODMAPs) — known triggers of irritable bowel syndrome (IBS) — showed significant benefits in improving symptoms in a prospective pre-post intervention study.

"We observed clinically meaningful improvements in symptom severity over four weeks, including improvements in abdominal pain and bloating, which are often among the most bothersome symptoms for patients," first author Eden Koo, MD, of the Division of Gastroenterology and Hepatology at the University of Michigan in Ann Arbor, told Medscape Medical News. 

"What is particularly interesting is the potential for this approach to help patients manage food-related symptoms without necessarily having to eliminate those foods from their diets," he said.

Koo presented the study this week at the American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting. 

Challenge of Dietary Approaches 

IBS can be particularly challenging to manage because symptoms are often influenced by multiple factors, including diet, and responses to existing treatments can vary considerably between patients.

Dietary approaches, most notably the low-FODMAP diet, show encouraging efficacy, but adherence to the diet's restrictions over the long term can be difficult. 

Targeted digestive enzymes such as lactase and alpha-galactosidase have long been available and can be of benefit by helping to manage dietary triggers while maintaining greater flexibility with food choices, Koo explained.

The current combination "provides a way to target several common dietary triggers simultaneously" including fructan, he said.

Furthermore, unlike traditional IBS therapies that primarily focus on managing symptoms, the enzyme approach is intended to act early to address certain dietary carbohydrates before they contribute to symptoms. However, there is limited evidence supporting targeted fructan breakdown and combined enzyme formulations for overall IBS symptom management.

Targeting 3 out of 5 FODMAPS 

Koo and his colleagues conducted a prospective, single-arm study, enrolling 442 participants with IBS — either self-reported, physician-diagnosed and/or with Rome IV criteria — who completed baseline and 4-week follow-up assessments. 

Over the 4 weeks, the participants used the supplement (Fodzyme, Kiwi Biosciences), which targets 3 of the 5 FODMAPs of fructans, galacto-oligosaccharides, and lactose. The supplement is designed to be mixed or sprinkled directly into food to help break down key FODMAPs during digestion, Koo explained.

The participants had a mean age of 50.3 years, and the majority (86.0%) were female. Among them, 46.6% had been following a low-FODMAP diet at baseline and 4 weeks.

For the primary outcome, over the 4-week course of the study, the participants' mean IBS symptoms, based on the IBS Symptom Severity Score (IBS-SSS), decreased significantly from 269.7 to 167.3 at 4 weeks, for a mean paired change of -102.4 (P < .001), with improvements in abdominal pain, bloating, and diet satisfaction.

Improvements were observed across a variety of IBS-SSS domains, including pain severity (50.0 at baseline vs 38.3 at 4 weeks), pain frequency (5.9 vs 3.9, respectively), distension severity (61.7 vs 43.2), bowel dissatisfaction (71.2 vs 47.2), and life interference (60.8 vs 38.4; P < .001 for all).

The benefits were also observed consistently across IBS subtypes of IBS-C (with prominent constipation), IBS-D (with prominent diarrhea), and IBS-M (mixed bowel habits). 

Meaningful improvement, defined as at least a 50-point IBS-SSS reduction, occurred among 69.2% of participants, while 52.3% achieved at least a 100-point reduction.

In further assessments by Patient-Reported Outcomes Measurement Information System score, belly pain declined from a score of 62.8 to 57.9, while bloating declined from 63.2 to 58.7 (both P < .001). As many as 43.7% of belly pain responders had at least a 5-point improvement, and 41.0% of bloating responders had at least a 5-point improvement.

Of note, participants reported an increase in satisfaction with their diet over the 4 weeks from 2.7 to 3.0 (a 0.28 mean improvement), with no significant differences based on IBS subtype.

"We were encouraged by the magnitude of symptom improvement observed in our study," Koo said. He cautioned, however, that "an important distinction is that our study was observational and did not include a placebo or control group."

"I think our findings provide an encouraging signal that this approach deserves further evaluation, ideally through randomized, placebo-controlled trials," he said.

"If future controlled studies confirm these findings, targeted enzyme supplementation could become a useful addition to our existing dietary management strategies, potentially allowing patients greater dietary flexibility while maintaining symptom control."

Appealing, but Not Ready for Clinical Recommendation 

Commenting on the research, gastroenterologist V. Raman Muthusamy, MD, a clinical professor of medicine at the David Geffen School of Medicine at UCLA, Los Angeles, agreed that the results are intriguing.

"If there's a prophylactic measure that can either be taken as a supplement or just incorporated into your diet, that could be appealing to patients and providers," Muthusamy told Medscape Medical News.

However, "while the preliminary findings are, I would say, hypothesis-generating, I think more work needs to be done to get this to the point where we could recommend it in clinical practice," he said. "We'll need to see more data." 

Koo and Muthusamy had no disclosures to report. A member of the study team was an employee of Kiwi Biosciences.