Safety and Tolerability of Serum Derived Bovine Immunoglobulin in Children With Diarrhea Predominant IBS

The study will consist of four phases:

Screening Phase: screen the patients for 2 weeks prior to enrollment in the study to
establish objective criteria of disease presence and severity. Patients will maintain a daily
symptom dairy. At the end of screening phase, we will calculate their quality of life and
symptom severity scores based on the information provided by the patients and their family.
Patients with an average score of 1 or greater over 14 days for abdominal pain and stool
consistency will be selected for the open label trial of SBI.

Open Label Treatment Phase: patients enrolled will receive 4 weeks of SBI along with QOL
questionnaires to complete. If the patient's global assessment is that they have improved, or
if review of their diaries shows an improvement in symptom severity scores (decrease in
symptom severity score by > 30% from baseline), they will be eligible for the randomization
phase.

Patients, who do not have any improvements during the first 4 weeks of SBI therapy, will not
be randomized. If non-responders have worsening of symptoms, they will be prescribed rescue
medications as per standard of care. If non-responders choose to continue to take SBI, they
will be so allowed.

Randomization Phase: Patients who qualify for this phase will be randomized either to SBI or
placebo. They will take their medication for 4 more weeks and complete their questionnaires,
symptom as well as QOL. After this 4 week phase all patients will be offered the Open Label
Extension Phase.

Open Label Extension Phase: All patients who enter this phase will be treated with SBI for
another 16 weeks.

Inclusion Criteria:

- Male or female patients > 8 years of age and < 18 years of age

- Patients with a diagnosis of IBS-D as per Rome III criteria

- Patients with normal laboratory work up (CBC, ESR, CRP, amylase, lipase, celiac panel,
fecal occult blood)

- Patients with normal fecal calprotectin and lactose hydrogen breath test

- Patients off motility drugs, NSAIDs for at least 2 weeks prior to enrollment in the
study

- Ability to complete the study

- Patients on stable doses or other medications for at least 4 weeks prior to enrollment

Exclusion Criteria:

- Patients with h/o other GI, hepatic, renal, cardiovascular, neurologic or
hematological disorder

- Patients with family history of inflammatory bowel disease

- Patients with history of abdominal surgery

- Patient with history of drug or alcohol abuse

- Patient with a history of allergy to study related products (e.g. beef)

- Use of probiotics in the previous month

- Patients who used SBI in the past

- Patients with soy allergy/sensitivity