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In diarrhea-predominant irritable bowel syndrome (IBS-D), the colon is endoscopically and histologically normal, but there is some evidence of immune activation.
To assess the potential efficacy of slow-release mesalamine in IBS-D, researchers randomized 136 patients to receive mesalamine (4 g per day) or placebo for 12 weeks in an industry-supported, double-blinded study. The primary endpoint of daily average stool frequency at weeks 11 to 12 was 2.8 with mesalamine and 2.7 with placebo (P=0.66). No improvement occurred in abdominal pain, stool consistency, or the percentage of patients with satisfactory symptom relief.