- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01373970
The Clinical Significance of Acid Rebound in Functional Dyspepsia (CLARIFY)
The Clinical Significance of Acid Rebound: Symptoms of Reflux After PPI Treatment in Patients With Functional Dyspepsia
Proton pump inhibitors (PPI) have been shown to cause acid reflux related symptoms at withdrawal in healthy volunteers, a phenomenon known as Rebound Acid Hyper Secretion. Whether this also applies for patients with dyspeptic symptoms but without true reflux disease (functional dyspepsia) treated with PPI is unknown. If this is the case, it could lead to an unfortunate long term use of PPI, since the acid rebound renders withdrawal too difficult.
This is a single centre, randomized, double-blinded, placebo-controlled cross over study. Study period is 12 weeks per study subject. Study subjects are referred to the study from General Practitioner (GP) and the gastroenterology department or endoscopy clinic of the investigational centre.
The study population consists of patients who seek their GP because of dyspepsia without alert signs, and whom the GP may consider starting on PPI. Out patients referred to the gastroenterology department or endoscopy clinic of the investigational centre because of dyspepsia without specific exclusion criteria are also invited to participate.
Baseline interview, upper endoscopy and pH monitoring are performed one week before inclusion to exclude patients with GERD. Helicobacter Pylori (Hp.) status is assessed by Helicobacter Urease Test (HUT). Hp. positive subjects without ulcus are not excluded.
Patients with a positive pH monitoring will not be included in the analysis regarding the primary endpoint (Development of GERD) but will be included in the analysis regarding one of the secondary endpoints (Effect of PPI on Functional Dyspepsia).
Study subjects are randomized to either pantoprazol followed by cross over to placebo or to placebo. Escape medication in the form of Gaviscon can be used on demand.
Internet based questionnaires are answered weekly. Questionnaires consist of the Gastrointestinal Symptom rating Scale (GSRS) in combination with items assessing postprandial fullness and items assessing the Montreal Criteria for Gastro Esophageal Reflux Disease (GERD).
Compliance to protocol is assessed at hospital visits every fourth week. At the end of study endoscopy and pH monitoring are repeated.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
-
Koege, Denmark, 4600
- Koege Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Symptoms indicating dyspepsia, including:
- Epigastric pain or epigastric discomfort
- Bothersome postprandial fullness
- Early satiation
- Epigastric burning
- Access to internet
Exclusion Criteria:
- Daily use of PPI or H2-receptor antagonists in more than 28 days within the last 120 days OR more than two days within the last 28 days OR more than five non-consecutive days within the last 28 days.
- Mild heartburn or regurgitation more than once per week
- Moderate or severe heartburn or regurgitation at least once per week
- Complications to GERD (esophagitis, stricture or Barrett's esophagus) prior to enrolment or at screening
- Abnormal findings at upper endoscopy necessitating treatment
Abnormal pH-monitoring prior to enrolment or at screening (pH <4 in ≥5.5 % of the time on "worst day" of 48-h monitoring)
- Excludes data from analysis regarding primary endpoint (see summary)
- Previous surgery on esophagus, stomach or duodenum
- Regular use of NSAIDs through the last six months
- Potential language problems in understanding information and registering symptoms
- Pregnancy or breast feeding
- Other diseases which can interfere with the symptom registration (severe congestive heart disease, malignant disease, schizophrenia ect.)
- Abuse of alcohol/narcotics
- Allergy/intolerance to gelatine or lactose used in placebo
- Patients with pacemaker, Implantable Cardioverter Defibrillator or Implantable Neurostimulator
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
|
Placebo, one tablet daily for 12 weeks
|
Active Comparator: PPI + Placebo
PPI followed by cross over to placebo
|
Pantoprazole 40 mg, one tablet daily in eight weeks followed by a blinded cross over to placebo, one tablet daily for four weeks
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Development of GERD
Time Frame: week 9 - 12
|
Comparison of number of study subjects that develop GERD according to the Montreal definition including endoscopic findings and pH monitoring in weeks 9-12 in the PPI group versus the placebo group.
|
week 9 - 12
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Use of escape medication
Time Frame: Week 9 - 12
|
Difference in use of escape medication in weeks 9 - 12 between PPI- and placebo group
|
Week 9 - 12
|
Endoscopic findings
Time Frame: 0 - 2 weeks before inclusion
|
Number of study subjects who have esophagitis, peptic stricture or Barrett's esophagus at inclusion without having symptoms of reflux.
|
0 - 2 weeks before inclusion
|
pH monitoring
Time Frame: 0 - 2 weeks before inclusion
|
Number of study subject who have an abnormal pH monitoring at inclusion with-out symptoms of reflux
|
0 - 2 weeks before inclusion
|
Irritable Bowel Syndrome (IBS)
Time Frame: 0 - 2 weeks before inclusion
|
Number of study subjects with ROME III score indicating IBS at inclusion
|
0 - 2 weeks before inclusion
|
Irritable Bowel Syndrome (IBS) and treatment
Time Frame: Week 0 - 12
|
Difference in symptom scores between study subjects with and without IBS in the PPI- and placebo group in weeks 0 - 12
|
Week 0 - 12
|
Effect of PPI on Functional Dyspepsia
Time Frame: Week 8
|
Number of study subjects in the PPI group versus the placebo group that answer "no discomfort at all" or "slight discomfort" to dyspepsia related questions ("ache/pain in the upper part of the abdomen" and "hunger pains/hollow feeling in the stomach") in week 8.
|
Week 8
|
Helicobacter Pylori
Time Frame: Week 9 - 12
|
Difference in symptom score for subject with and without H.
Pylori between PPI- and placebo group in weeks 9 - 12.
|
Week 9 - 12
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Anders B. Lødrup, MD, Zealand University Hospital
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- SJ-217
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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