- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02360384
Caecal pH as a Biomarker for Irritable Bowel Syndrome
A Randomised Controlled Trial to Validate the Use of Caecal pH Measurement as a Biomarker in Irritable Bowel Syndrome
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Irritable bowel syndrome (IBS) is an extremely common condition. Between 1.9 and 3.6 million patients consult a healthcare professional for IBS each year in the UK (1). The total population prevalence is much higher as most IBS sufferers are non-consulters due to the perceived lack of effective treatments. IBS can be sub-classified based upon predominating bowel habit, i.e. constipation predominant (IBS-C), alternating bowel habit (IBS-A) or diarrhoea predominant (2). In recent years, several efficacious treatment approaches have been applied to IBS including dietary interventions (low fibre and low fermentable oligosaccharides, disaccha¬rides, monosaccharides and polyols (FODMAP)), probiotics (VSL#3) and pharmacological agents (linaclotide) (3). Whilst each of these treatment approaches have shown efficacy, it is clear that further refinement of the IBS diagnostic algorithm is required to better target therapies in order to overcome the inherent heterogeneity within the IBS population.
Bloating and distension are both common and vexatious symptoms in a proportion of IBS patients. Bloating is largely regarded as a subjective sensation of abdominal swelling, whereas distension refers to an observable increase in abdominal girth. Bloating is associated with a reduction in quality of life, is a cause for healthcare seeking and represents a considerable challenge to manage effectively.
The anaerobic breakdown of carbohydrates and protein by bacteria, largely occurring within the proximal colon, is through a process known as fermentation, the principal products of which are short chain fatty acids (SCFA). One of the proposed mechanisms of bloating and distension is colonic dysbiosis and subsequent mal-fermentation. This has been supported by data which show that a large proportion of IBS patients improve symptomatically when restricting their diet to an 'elemental' formula for 2-4 weeks thus reducing the amount of fermentable material in the intestinal lumen.
The direct in vivo measurement of SCFA concentrations in the human proximal colon is technically difficult and invasive. Given that the degree of bacterial fermentation is directly proportional to the concentration of SCFA, the measurement of segmental intra-colonic pH is an inverse surrogate proxy of the degree of fermentation occurring within that territory. We have recently shown that measurement of caecal pH using the wireless motility capsule (WMC) in IBS and control patients is both technical feasible and able to differentiate between the two populations (4).
Our study showed that caecal pH is significantly lower in IBS when compared to controls thus supporting the concept that mal-fermentation is contributing to IBS symptomatology. Importantly, we have also shown that caecal pH is correlated with inhibition of caecal contractility which has led us to propose the idea that 'caecoparesis' maybe the long sought after alteration in motor function which differentiates IBS patients from healthy participants and explains why IBS preferentially experience pain in the right colon and upper abdomen in response to balloon distension.
TRIAL OBJECTIVES The primary aim of this study is to demonstrate that caecal pH is a sensitive and reliable biomarker of caecal fermentation in IBS and that normalisation of the caecal pH environment will correlate with symptomatic improvement in IBS patients. We hypothesise that normalisation of the caecal pH environment with either dietary intervention or linaclotide will correlate with symptomatic improvement in IBS patients. To achieve this we will recruit a cohort of Rome III defined IBS patients and sub-divide them into the appropriate IBS type based on symptoms. We will then characterise their phenotype in terms of gastro-intestinal physiology (WMC + lactulose hydrogen breath test) and psychological profile. They will then be allocated to one of (2 or 3) treatment arms (control diet, low FODMAP diet, control diet + linaclotide). Each treatment arm will last for 28 days after which WMC will be repeated and symptoms assessed. Secondary aims will include characterising motility and transit in IBS-sub groups, determining the effect of the interventions of motility and transit, comparison of ileal and caecal pH profiles with hydrogen / methane breath testing data and comparison of symptom change and physiological assessment outcomes.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
London, United Kingdom, E1 @AJ
- Wingate Institute of Neurogastroenterology
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Ability to provide Informed written consent
- Age (18-65 years old)
- Male and female patients with irritable bowel syndrome of the alternating or constipation subtype.
Exclusion Criteria:
- Any inclusion criteria not met
- Participants unable to provide informed consent.
- Participants on any medications that may influence gastrointestinal motility (e.g. beta-agonists).
- Pregnancy.
- Recent antibiotic use in the preceding 4 weeks.
- Recent probiotic use in the last 2 weeks, concurrent use of promotile medications.
- Participants with IBS-C who are already taking linaclotide or have known hypersensitivity to linaclotide.
- History of a systemic disorder with known gastrointestinal manifestations (such as diabetes mellitus, connective tissue disorders etc.) and previous gastrointestinal tract surgery will be treated as criteria for exclusion. Specific contraindications to WMC are dysphagia, recent abdominal surgery, Crohn's disease, planned MRI and diverticulitis.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: DIAGNOSTIC
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
PLACEBO_COMPARATOR: Sham diet
The placebo intervention will be healthy eating advice in patients with irritable bowel syndrome of the alternating subtype for 28 days.
|
Linaclotide 290mcg po od in all patients with irritable bowel syndrome with constipation.
Other Names:
|
ACTIVE_COMPARATOR: Lincalotide
All patients with constipation predominant IBS will receive linaclotide 280mcg po od for 28 days.
|
Linaclotide 290mcg po od in all patients with irritable bowel syndrome with constipation.
Other Names:
|
EXPERIMENTAL: FODMAP diet
The FODMAP diet will be introduced in patients with irritable bowel syndrome of the alternating subtype for 28 days.
|
Patients with irritable bowel syndrome with alternating bowel habit will be commenced on the either the low FODMAP diet or a control healthy eating diet.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To evaluate the change in pH around the ileocaecal valve in response to dietary intervention or linaclotide.
Time Frame: 28 days
|
Change in pH around the ileocaecal valve using the wireless motility capsule in response to the dietary intervention and linaclotide
|
28 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in caecal pH and its association with the degree in symptomatic improvement using the IBS-symptom scale
Time Frame: 28 days
|
The change in caecal pH association and it is association with the magnitude of improvement in symptoms using the validated IBS-SSS questionnaire
|
28 days
|
Motility patterns and transit in subtype IBS patients, according to the Rome III criteria, using the wireless motility capsule
Time Frame: 1-2 days
|
1-2 days
|
|
The effect of the interventions on symptoms using the validated questionnaires of IBS-SSS
Time Frame: 28 days
|
28 days
|
|
The effect of the interventions on quality of life measures using the validated Eq-5D
Time Frame: 28 days
|
28 days
|
Collaborators and Investigators
Investigators
- Principal Investigator: Adam D Farmer, PhD MRCP, Wingate Institute of Neurogastroenterology
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
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
- Digestive System Diseases
- Pathologic Processes
- Disease
- Gastrointestinal Diseases
- Colonic Diseases, Functional
- Colonic Diseases
- Intestinal Diseases
- Syndrome
- Irritable Bowel Syndrome
- Molecular Mechanisms of Pharmacological Action
- Gastrointestinal Agents
- Guanylyl Cyclase C Agonists
- Enzyme Activators
- Linaclotide
Other Study ID Numbers
- WMC1
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.
Clinical Trials on Irritable Bowel Syndrome
-
ProgenaBiomeRecruitingIrritable Bowel Syndrome | Irritable Bowel Syndrome With Diarrhea | Irritable Bowel Syndrome With Constipation | Irritable Bowel Syndrome Characterized by Constipation | Irritable Bowel Syndrome Mixed | Irritable Bowel Syndrome Without Diarrhea | Irritable Bowel | Irritable Bowel Syndrome Aggravated and other conditionsUnited States
-
ClasadoCR2O B.V.RecruitingIrritable Bowel Syndrome | Irritable Bowel Syndrome - Constipation | Irritable Bowel Syndrome - Diarrhoea | Irritable Bowel Syndrome - MixedBelgium, Netherlands, United Kingdom
-
Istanbul Medipol University HospitalTepecik Training and Research Hospital; Bozyaka Training and Research Hospital and other collaboratorsRecruitingIrritable Bowel Syndrome | Irritable Bowel Syndrome With Diarrhea | Irritable Bowel Syndrome With Constipation | Irritable Bowel Syndrome MixedTurkey
-
Federal Stare Budgetary Scientific Institution,...I.M. Sechenov First Moscow State Medical University; RML INVEST, Torkhovsky...CompletedIrritable Bowel Syndrome | Irritable Bowel Syndrome With Diarrhea | Irritable Bowel Syndrome With Constipation | Irritable Bowel Syndrome MixedRussian Federation
-
University of California, Los AngelesCompletedIrritable Bowel Syndrome With Diarrhea | Irritable Bowel Syndrome With Mixed Bowel HabitsUnited States
-
University of ViennaCompleted
-
Thomayer University HospitalCharles University, Czech RepublicActive, not recruitingIrritable Bowel Syndrome With Diarrhea | Irritable Bowel Syndrome MixedCzechia
-
Shahid Beheshti University of Medical SciencesCompletedIrritable Bowel DiseaseIran, Islamic Republic of
-
GlaxoSmithKlineCompletedIrritable Bowel Syndrome (IBS) | Irritable ColonUnited States
-
Universidad Autonoma de ChihuahuaNot yet recruitingIrritable Bowel Syndrome | Constipation-predominant Irritable Bowel Syndrome | Diarrhea- Irritable Bowel Syndrome
Clinical Trials on Linaclotide
-
Forest LaboratoriesIronwood Pharmaceuticals, Inc.TerminatedIrritable Bowel Syndrome With ConstipationUnited States, Canada
-
AbbVieIronwood Pharmaceuticals, Inc.Active, not recruitingIrritable Bowel Syndrome With Constipation | Functional ConstipationUnited States, Belgium, Bulgaria, Canada, Estonia, Israel, Italy, Netherlands, Poland, Puerto Rico, Spain, Ukraine, United Kingdom, Germany
-
Forest LaboratoriesIronwood Pharmaceuticals, Inc.CompletedConstipation | Chronic ConstipationUnited States, Canada
-
Forest LaboratoriesIronwood Pharmaceuticals, Inc.Completed
-
Forest LaboratoriesIronwood Pharmaceuticals, Inc.CompletedChronic ConstipationUnited States, Canada
-
Ironwood Pharmaceuticals, Inc.Forest LaboratoriesCompletedIrritable Bowel Syndrome With ConstipationUnited States
-
Changhai HospitalThe First Affiliated Hospital of Nanchang University; The Second Hospital of... and other collaboratorsCompletedBowel Preparation for ColonoscopyChina
-
Astellas Pharma IncCompleted
-
Astellas Pharma IncCompletedIrritable Bowel Syndrome With Constipation (IBS-C)Japan
-
Ironwood Pharmaceuticals, Inc.CompletedIrritable Bowel Syndrome With ConstipationUnited States, Canada