Exhibit 4.22





THE SYMBOL "[****]" DENOTES PLACES WHERE PORTIONS OF THIS DOCUMENT HAVE
BEEN OMIITTED PURSUANT TO A REQUEST FOR CONFIDENTIAL TREATMENT. SUCH MATERIAL HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND
EXCHANGE COMMISSION









REDHILL
BIOPHARMA LTD

Change
Specification Form

(Q2Solutions,
a Quintiles Quest Joint Venture)





|Protocol:                                                                                                                                                                                                                                           | Requester:             
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -----------------------
|RHB-104-01                                                                                                                                                                                                                                          | Patrick McLean         
|Proposed
    date                                                                                                                                                                                                                                   | Project
    Manager(s):
|of Implementation:                                                                                                                                                                                                                                  | Fitt,Penny             
|6 weeks from approval                                                                                                                                                                                                                               | KLINGLER, MARIANA      
|Original
    Specifications (if applicable):                                                                                                                                                                                                       
|N/A                                                                                                                                                                                                                                                
|Change
    in Specifications/New Specifications:                                                                                                                                                                                                   
|Addition of [****]. [****] sites, [****] patients randomized in one year with
the first patient in [****], [****]. We are assuming a [****] screen failure rate. This country is to follow the EU MAP process.                                     
|                                                                                                                                                                                                                                                   
|Please
    see details of changes :                                                                                                                                                                                                                
|☒
    Database                                                                                                                                                                                                                                     
|☒
    Addition of investigator site (Per site) [****]                                                                                                                                                                                              
|☒
    Investigator Manual                                                                                                                                                                                                                          
|☒
    Create/Update contact & transport appendix/SSIs                                                                                                                                                                                              
|☒ Management
    Fees                                                                                                                                                                                                                              
|☒
    Administration fee                                                                                                                                                                                                                           
|☒
    Requisition(s) including Starter/Reorder Forms                                                                                                                                                                                               
|☒
    Forms (Requisitions/Starter pack/Reorder) : update 1-3                                                                                                                                                                                       
|                                                                                                                                                                                                                                                    |                        
|Total
    Amendment Fee: $ [****] for account 64160601 (US)                                                                                                                                                                                        
|This Change Specification Form includes the cost of the amendment fee associated with the above noted change(s). The amendment budget will include any additional supply, testing, or transportation charges incurred as a result of these changes.





Comments



Reviewer’s Name:



|Signature: | /s/ Uri Hananel Aharon, CAO |  | Date: | Sep. 17, 2015 | 
|---------- | --------------------------- |  | ----- | ------------- | 
|           |                             |  |       |               | 
|Signature: | /s/ Ori Shilo, Deputy CEO   |  | Date: | Sep. 17, 2015 |