Ileocecal Sphincter Reflex by Cecal Distension During Colonoscopy

Evaluation of the Ileocecal Valve in Patients With and Without Irritable Bowel Syndrome.(IBS)

The aim of the current study is to test the hypothesis that patients with IBS may have a defective ICV pressures and may have small bowel bacterial overgrowth. The goal of the current study is to identify the role and competence of ileocecal valve (ICV) in patients with irritable bowel syndrome.

The primary objective is to measure the pressure of the ileocecal valve in patients with and without irritable bowel syndrome (IBS). The Ileocecal valve reflux pressures during air insufflation of cecum will be used.

Study Overview

• Status: Terminated
• Conditions: Irritable Bowel Syndrome

Detailed Description

This is an outpatient study. There will be no requirement to stay overnight in the hospital. The research will be conducted in the gastroenterology section of the department of Medicine in North shore university hospital and in North shore long island Jewish medical center. Both these hospitals are tertiary care centers with adequate facilities for the safe and appropriate conduct of this research. Participants must meet all eligibility criteria and sign the consent form before enrolling in the study. This is a cohort study with 2 groups (patients with IBS and participants without IBS). Patients will be enrolled into one of these two categories based on their medical history, signs and symptoms and questionnaire. There are no controlled compounds used in this study. There is no treatment involved in this study. There are 2 study related visits per subject.

Based on questionnaire we plan to recruit 25 participants who meet the criteria of IBS and 25 participants who do not meet the criteria of IBS (Total of 50 participants in the study). Patients with IBS are those who meet the criteria of IBS based on their symptoms and the responses to a validated ROME III - questionnaire. All other participants who do not meet the criteria for IBS are classified as non-IBS participants. All the participants should be having a clinically indicated colonoscopy.

• Study Type: Observational
• Enrollment (Actual): 2

Contacts and Locations

Study Locations

• United States
  • New York
    • New Hyde Park, New York, United States, 11040
      • LIJ Medical Center- NSLIJ Health System

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients with who are undergoing routine screening colonoscopies.

Description

Inclusion Criteria:

• Patients with a history of small bowel bacterial overgrowth or irritable bowel syndrome and who are undergoing routine colonoscopies or subjects who are undergoing routine colonoscopy and test positive for small bowel bacterial overgrowth will be candidates. If the patient has prior lactulose breath test done for clinical purposes then repeat lactulose breath test will not be required. If no prior lactulose breath test has been performed then it will be done as part of this research study. In addition patients who test negative for SBBO will be candidates for the control population.

Exclusion Criteria:

• Medications-Subjects on any medication that could affect the ileocecal valve high-pressure zone will be excluded; this includes use of prokinetic agents, current use of any antibiotics and anticholinergics. Patients will be excluded if the lactulose breath test is done on antibiotics or during the colonoscopy preparation.

GI symptoms, conditions and disorders: In addition exclusion criteria will include a history of ileocecal resection or disease affecting the colon and/or small bowel including crohn's disease, ulcerative colitis or diseases causing diarrhea.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Normal volunteers; Normal volunteers without Irritable bowel syndrome who are undergoing screening colonoscopy.
Irritable bowel syndrome; Patients with Irritable bowel syndrome are undergoing colonoscopy as standard of care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Pressure generated in ICV during Cecal distention	10-15 minutes

Collaborators and Investigators

• Sponsor: Northwell Health
• Investigators: Principal Investigator: Larry S Miller, MD, Northwell Health

Publications and helpful links

General Publications

• GAZET RJ, JARRETT J. THE ILEOCAECO-COLIC SPHINCTER. STUDIES IN VITRO IN MAN, MONKEY, CAT, AND DOG. Br J Surg. 1964 May;51:368-70. doi: 10.1002/bjs.1800510519. No abstract available.
• SINGLETON AO Jr, REDMOND DC 2nd, MCMURRAY JE. ILEOCECAL RESECTION AND SMALL BOWEL TRANSIT AND ABSORPTION. Ann Surg. 1964 May;159(5):690-4. doi: 10.1097/00000658-196405000-00006. No abstract available.
• Jarrett RJ, Gazet JC. Studies in vivo of the ileocaeco-colic sphincter in the cat and dog. Gut. 1966 Jun;7(3):271-5. doi: 10.1136/gut.7.3.271. No abstract available.
• Kelley ML Jr, Gordon EA, Deweese JA. Pressure responses of canine ileocolonic junctional zone to intestinal distention. Am J Physiol. 1966 Sep;211(3):614-8. doi: 10.1152/ajplegacy.1966.211.3.614. No abstract available.
• Cohen S, Harris LD, Levitan R. Manometric characteristics of the human ileocecal junctional zone. Gastroenterology. 1968 Jan;54(1):72-5. No abstract available.
• Castell DO, Cohen S, Harris LD. Response of human ileocecal sphincter to gastrin. Am J Physiol. 1970 Sep;219(3):712-5. doi: 10.1152/ajplegacy.1970.219.3.712. No abstract available.
• Griffen WO Jr, Richardson JD, Medley ES. Prevention of small bowel contamination by ileocecal valve. South Med J. 1971 Sep;64(9):1056-8. doi: 10.1097/00007611-197109000-00006. No abstract available.
• Pahlin PE, Kewenter J. Sympathetic nervous control of cat ileocecal sphincter. Am J Physiol. 1976 Aug;231(2):296-305. doi: 10.1152/ajplegacy.1976.231.2.296.
• Stremmel W, Kurpreugsch K, Langewitz W. [Hormonal and pharmacological modification of the ileocecal sphincter]. Chir Forum Exp Klin Forsch. 1977 Apr:45-8. German.
• King CE, Toskes PP. Small intestine bacterial overgrowth. Gastroenterology. 1979 May;76(5 Pt 1):1035-55. No abstract available.
• Rubin MR, Fournet J, Snape WJ Jr, Cohen S. Adrenergic regulation of ileocecal sphincter function in the cat. Gastroenterology. 1980 Jan;78(1):15-21. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): June 21, 2013
• Primary Completion (Actual): August 5, 2015
• Study Completion (Actual): January 18, 2017

Study Registration Dates

• First Submitted: August 9, 2011
• First Submitted That Met QC Criteria: August 9, 2011
• First Posted (Estimate): August 10, 2011

Study Record Updates

• Last Update Posted (Actual): February 22, 2019
• Last Update Submitted That Met QC Criteria: February 20, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Keywords: Irritable bowel syndrome; Ileocecal valve; small bowel bacteria
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Disease; Gastrointestinal Diseases; Colonic Diseases, Functional; Colonic Diseases; Intestinal Diseases; Syndrome; Irritable Bowel Syndrome
• Other Study ID Numbers: 13-216B

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO