Participant must provide written or verbal informed assent and the parent/guardian/LAR must provide written informed consent before the initiation of any study-specific procedures
Participant is a male or female outpatient, 6 to 17 years of age inclusive, at the time the participant provides assent for the study and parent/guardian/LAR has provided signed consent
Participant is able to read and understand the assessments in the eDiary. If the participant is 6 to 11 years of age and does not meet this criterion, the interviewer-administered version of the eDiary must be used and the parent/guardian/LAR or caregiver who will be administering the interviewer-administered version of the eDiary must be able to read and understand the assessments in the eDiary and must undergo training
Female participants of childbearing potential must have a negative serum pregnancy test at Visit 1 (screening) and a negative urine pregnancy test at Visit 3 (randomization) prior to dosing
Female participants who have had their first menstrual period and are sexually active must agree to use a reliable form of contraception. Reliable contraception is defined
as
Hormonal contraception (eg, oral contraceptive, contraceptive implant, or injectable hormonal contraceptive)
Double-barrier method (eg, condom plus intrauterine device, diaphragm plus spermicide)
Participant has a diagnosis of IBS-D as defined by the modified Rome IV
child/adolescent criteria: Must include all of the following
\-- Abdominal pain at least 4 days per month over at least 2 months associated
with one or more of the following
Related to defecation
A change in frequency of stool
A change in form (appearance) of stool
After appropriate evaluation, the symptoms cannot be fully explained by another medical condition
Participant has predominantly diarrheal stool symptoms defined as Bristol stool types 6 or 7 for more than 25% of bowel movements and Bristol stool types 1 or 2 for less than 25% of bowel movements that occur in the absence of laxative
All criteria fulfilled for at least 2 months prior to Visit 1 (screening)
Participant has been compliant with the eDiary by completing both the morning and
Participant has an average daytime abdominal pain scoreless than or equal to 2.0 over the 2 weeks prior to randomization
evening assessments for at least 8 out of the 14 days immediately preceding
Participant has at least 1 daytime bowel movement with a consistency of Type 6 or Type 7 on the pediatric Bristol Stool Form Scale (p-BSFS) on at least 2 days per week during the 2 weeks prior to randomization that occurs in the absence of laxatives
Visit 3 (randomization)
Participant has no clinically significant findings on a physical examination, vital sign assessment, electrocardiogram (ECG), and clinical laboratory tests (clinical chemistry panel, liver biochemical tests, complete blood count, urine drug screen, urinalysis) after providing informed assent and after written consent is obtained, but before receiving the first dose of study treatment. (A central laboratory will be used to evaluate all urine [except urine pregnancy tests] and blood samples and will utilize reference ranges specific to a patient's age and gender. ECGs will be performed and electronically transmitted to a central ECG laboratory for analysis by a pediatric cardiologist in accordance with the instructions provided by the central ECG laboratory. The Investigator will determine if a particular finding is clinically significant. [In making this determination, the Investigator will consider whether the particular finding could represent a condition that would exclude the participant from the study, could represent a safety concern if the participant participates in the study, or could confound the study-specific assessments of safety or efficacy.])
Yes for Participant has no clinically significant findings on a physical examination, vital sign assessment, electrocardiogram (ECG), and clinical laboratory tests (clinical chemistry panel, liver biochemical tests, complete blood count, urine drug screen, urinalysis) after providing informed assent and after written consent is obtained, but before receiving the first dose of study treatment. (A central laboratory will be used to evaluate all urine [except urine pregnancy tests] and blood samples and will utilize reference ranges specific to a patient's age and gender. ECGs will be performed and electronically transmitted to a central ECG laboratory for analysis by a pediatric cardiologist in accordance with the instructions provided by the central ECG laboratory. The Investigator will determine if a particular finding is clinically significant. [In making this determination, the Investigator will consider whether the particular finding could represent a condition that would exclude the participant from the study, could represent a safety concern if the participant participates in the study, or could confound the study-specific assessments of safety or efficacy.]) inclusion criteria 24
No for Participant has no clinically significant findings on a physical examination, vital sign assessment, electrocardiogram (ECG), and clinical laboratory tests (clinical chemistry panel, liver biochemical tests, complete blood count, urine drug screen, urinalysis) after providing informed assent and after written consent is obtained, but before receiving the first dose of study treatment. (A central laboratory will be used to evaluate all urine [except urine pregnancy tests] and blood samples and will utilize reference ranges specific to a patient's age and gender. ECGs will be performed and electronically transmitted to a central ECG laboratory for analysis by a pediatric cardiologist in accordance with the instructions provided by the central ECG laboratory. The Investigator will determine if a particular finding is clinically significant. [In making this determination, the Investigator will consider whether the particular finding could represent a condition that would exclude the participant from the study, could represent a safety concern if the participant participates in the study, or could confound the study-specific assessments of safety or efficacy.]) inclusion criteria 24
Not sure for Participant has no clinically significant findings on a physical examination, vital sign assessment, electrocardiogram (ECG), and clinical laboratory tests (clinical chemistry panel, liver biochemical tests, complete blood count, urine drug screen, urinalysis) after providing informed assent and after written consent is obtained, but before receiving the first dose of study treatment. (A central laboratory will be used to evaluate all urine [except urine pregnancy tests] and blood samples and will utilize reference ranges specific to a patient's age and gender. ECGs will be performed and electronically transmitted to a central ECG laboratory for analysis by a pediatric cardiologist in accordance with the instructions provided by the central ECG laboratory. The Investigator will determine if a particular finding is clinically significant. [In making this determination, the Investigator will consider whether the particular finding could represent a condition that would exclude the participant from the study, could represent a safety concern if the participant participates in the study, or could confound the study-specific assessments of safety or efficacy.]) inclusion criteria 24
Participant has no gallbladder, (ie, agenesis of the gallbladder or cholecystectomy)
Participant has had any of the following surgeries
Any abdominal surgery within the 3 months prior to Screening; or
A history of major gastric, hepatic, pancreatic, or intestinal surgery. (Note: appendectomy, hemorrhoidectomy, or polypectomy greater than 3 months post-surgery are allowed. For the purposes of this study, laparoscopic surgeries without complication are considered minor and non-exclusionary, provided the condition for which the surgery was performed was not exclusionary.)
Participant has a history or current diagnosis of constipation with encopresis
Participant meets the child/adolescent Rome IV criteria of IBS with constipation, IBS with constipation and diarrhea (mixed), unspecified IBS, or functional constipation
Participant has a history of chronic or severe constipation or sequelae from
Participant has a history of intestinal obstruction, stricture, toxic megacolon, GI perforation, fecal impaction, gastric banding, bariatric surgery, adhesions, ischemic colitis, or impaired intestinal circulation
Participant has a documented history of hepatic impairment as defined by Child-Pugh Classification Grade A, B or C
constipation, or known or suspected mechanical GI obstruction or pseudo
Participant has a history or current diagnosis of inflammatory or immune-mediated lower GI disorders including inflammatory bowel disease (eg, Crohn's disease, ulcerative colitis, microscopic colitis). Crohn's disease affecting the upper GI tract would also be exclusionary
obstruction
Participant has celiac disease, or a positive serological test for celiac disease and the condition has not been ruled out by endoscopic biopsy
Participant has any congenital and/or acquired malabsorption syndrome (eg, Shwachman-Diamond syndrome)
Participant has a history of a microbiologically documented (ie, stool culture or medical history) GI infection within 3 months prior to Screening
Participant has a known lactose or fructose intolerance that is associated with diarrhea, abdominal pain or discomfort, and that could confound assessments in the study
Participant has a history of diverticulitis within 3 months prior to Screening