- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01485341
Gluten Sensitivity in Non-Celiac Patients (GS)
Double Blind Randomized Placebo Controlled Multicenter Trial (Gluten vs Placebo) in Gluten Sensitive Subjects
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Gluten is the most important protein component of some grains, notably wheat, rye, and barley, which are the basis for a variety of flour and wheat derived alimentary products consumed throughout the world (bread, pasta, pizza etc). However the "engineering" of gluten-containing grains created the conditions for human diseases related to gluten exposure. These forms of gluten intolerance represent a heterogeneous set of conditions, including wheat allergy, Gluten Sensitivity and Celiac Disease, that, combined, affect about 10% of the general population. The frequency of not-celiac gluten intolerance is however still unknown, even though it is possible that these conditions have been undiagnosed and under-diagnosed by the physicians for long time. The state of immune responsiveness to wheat antigens, represents a complex process, and its establishment and maintenance are not completely elucidated. The most frequent diseases caused by wheat ingestion are T cell-mediated disorders, IgE-mediated allergic reactions and celiac disease (CD).
However, besides CD and wheat allergy, there are cases of gluten reactions in which neither allergic nor autoimmune mechanisms are involved. These are generally defined as gluten sensitivity (GS). Some individuals, who experience distress when eating gluten-containing products and show improvement when following a gluten-free diet, may have GS instead of CD. GS patients are unable to tolerate gluten and develop an adverse reaction when eating gluten that usually, and differently from CD, does not lead to small intestinal damage. While the gastrointestinal symptoms in GS may resemble those associated with CD, the overall clinical picture is generally less severe and is not accompanied by the concurrence of tTG autoantibodies or autoimmune disease. Typically the diagnosis is made by exclusion, and an elimination diet and "open challenge" (i.e., the monitored reintroduction of gluten-containing foods) are most often used to evaluate whether health improves with the elimination or reduction of gluten from the diet.
This has two major aims:
- Evaluation of the effective dependence from the gluten of the clinical alterations presented by subjects with gluten sensitivity (GS). The study will be done after a period of gluten-free diet (washout of 15 days), comparing two groups of GS subjects: given gluten or placebo (15 days), followed by a further period (15 days) on gluten free diet .
- identification of possible markers (serological, gut barrier function, immunological and expression of tight junctions constitutive proteins) that may be of help to differentiate, in humans, the condition of gluten sensitivity (GS) from that of Celiac Disease (CD); these markers might be of help in the early diagnosis of GS versus CD especially in the case of discordant serology.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
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Ancona, Italy
- Università Politecnica delle Marche
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Avellino, Italy
- Gastroenterologia ed Endoscopia digestiva, Ospedale San Giuseppe Moscati
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Naples, Italy, 80138
- Gastroenterology, Second University of Naples
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Palermo, Italy
- Internal Medicine, Policlinico di Palermo
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Salerno, Italy
- Gastroenterology, University of Salerno
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San Giovanni Rotondo (Foggia), Italy
- Ospedale "Casa Sollievo della Sofferenza" - IRCCS -
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Massachusetts
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Boston, Massachusetts, United States, 02114
- Center for Celiac Research & Treatment, Yawkey Center for Outpatients Care
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adult patients with age between 18-65 with signs/symptoms compatible with gluten-triggered disorders
- Patients testing negative for celiac disease either by biopsy Marsh 0-1 or those who are HLA-DQ2 and DQ8 negative, as well as tTG and EMA negative
- Patients that improved on a gluten free diet
Exclusion Criteria:
- Subjects diagnosed with celiac disease (positive TTG and/or EMA, and histology positive with Marsh II or above);
- Subjects diagnosed with wheat allergy
- Subjects with Type 1 Diabetes (T1D)
- Subjects with Inflammatory Bowel Disease (ulcerative colitis or Crohn's disease)
- Pregnancy
- Subjects with Helicobacter Pylori infection and other gastrointestinal infection
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: gluten
gluten is administered blindly versus placebo for 15 days at 10 g/day
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gluten is administered once a day at 10g/day for 15 days
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Placebo Comparator: rice starch
placebo (rice starch) will be administered blindly versus gluten for 15 days at 10 g/day
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rice starch is administered once a day at 10 g/day for 15 days
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Symptoms evaluation according to 3 scales: score after 2 weeks of gluten ingestion
Time Frame: Change from baseline at 2 weeks
|
The evaluation will be made according to the score calculated on the basis of three evaluation scales: "Gastrointestinal Symptom Rating Scale "(GSRS), modified, provides a score ranging MIN=15/MAX=60; Extra-gastrointestinal symptoms evaluation scale, proposed on the basis of the symptoms most frequently observed in GS patients, provides a score ranging MIN=9/MAX=34; VQV scale proposed to evaluate the quality of life, provides a score ranging MIN=16/MAX=64.
Total score can be no less than 37 (MIN) and not more than 146 (MAX), with a cut-off of 55.
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Change from baseline at 2 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Bio-Markers to differentiate GS and CD
Time Frame: Change from baseline at 2 weeks
|
The identification of possible markers (serological, gut barrier function, immunological and expression of tight junctions constitutive proteins) that may be of help to differentiate, in humans, the condition of gluten sensitivity (GS) from that of Celiac Disease (CD); these markers might be of help in the early diagnosis of GS versus CD especially when the serology is discordant.
|
Change from baseline at 2 weeks
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Symptoms evaluation according to 3 scales: scores 2 weeks after completion of intervention
Time Frame: Return to baseline values at 4 weeks
|
The evaluation will be made according to the score calculated on the basis of three evaluation scales: "Gastrointestinal Symptom Rating Scale "(GSRS), modified, provides a score ranging MIN=15/MAX=60; Extra-gastrointestinal symptoms evaluation scale, proposed on the basis of the symptoms most frequently observed in GS patients, provides a score ranging MIN=9/MAX=34; VQV scale proposed to evaluate the quality of life, provides a score ranging MIN=16/MAX=64.
Total score can be no less than 37 (MIN) and not more than 146 (MAX), with a cut-off of 55.
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Return to baseline values at 4 weeks
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Collaborators and Investigators
Investigators
- Principal Investigator: Anna Sapone, MD, PhD, University of Campania "Luigi Vanvitelli"
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 61-2-9-2011
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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