- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02574611
Use of High Resolution Colonic Manometry in Studying Motility
September 22, 2021 updated by: Dr. Mark Korsten, James J. Peters Veterans Affairs Medical Center
Safety and Efficacy of High Resolution Manometry in Studying Colonic Motility and Iontophoretic Administration of Prokinetic Agents
An injury to the spinal cord (SCI) results in numerous medical complications, including gastrointestinal (GI) function.
Individuals with SCI may experience severe constipation (prolonged stool retention), incontinence (accidents), and overall difficulty in bowel evacuation.
While various treatments and medications have been established to address this complication, there is little knowledge relating to the overall colonic motility.
However, new technology such as High Resolution Colonic Manometry allows physicians to visualize high pressure contractions inside the colon, leading to a greater understanding of typical motility, a more accurate diagnosis, and an effective treatment.
In this study, the investigators propose to use this technology to understand the effects of SCI on colonic motility by comparing to normal colonic function observed in able-bodied (AB) individuals.
In addition, the investigators plan to study the effects of pharmacological treatments, such as neostigmine, on promoting peristaltic contractions in the colon as it is delivered across the skin.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Detailed Description
The investigators data suggests that the fundamental consequence of SCI is a slowing of intestinal peristaltic activity, most likely as a result of down regulation of parasympathetic neural pathways.
Furthermore, the investigators have effectively shown that measures involved in increase parasympathetic stimulation results in efficient bowel evacuation and improved bowel care.
Such measures include the administration of neostigmine (NEO), which increases peristaltic contractions in the colon, resulting in predictable bowel evacuations.
Given the cardiopulmonary side-effects of NEO, an ant-cholinergic known as Glycopyrrolate (GLY) is usually co-administered with NEO to reverse these side effects.
However, the investigators knowledge regarding the effects of SCI on colonic motility is still primitive, mainly due to pervious technological disadvantages.
New High Resolution Colonic Manometry systems (Medical Measurement Systems Dover, NH) simultaneously capture high amplitude pressure contractions (HAPCs) across the ascending, transverse, descending, and recto-sigmoid colon.
Such capabilities allow for a much clearer display of pressure events compared to previous line tracing manometric systems and the direction of contractions are much easier to discern as well.
To date, this technology has been an effective tool in diagnosing bowel disorders and complications, such as constipation in able-bodied individuals (AB).
However, such studies have not been conducted in a SCI population.
This technology also has the potential to capture the effects of NEO+GLY on improving colonic function.
Study Type
Interventional
Phase
- Phase 1
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
New York
-
Bronx, New York, United States, 10468
- James J. Peters VA Medical Center
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years to 73 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Chronic SCI >1year
- Able-Bodied (non SCI)
- Undergoing Elective Colonoscopy
- Age 18-75 years.
Exclusion Criteria:
- Previous adverse reaction or hypersensitivity to electrical stimulation
- Known sensitivity to neostigmine or glycopyrrolate
- Persons with SCI who do not require additional bowel care or have "normal bowel function"
- Known hypersensitivity to neostigmine or glycopyrrolate
- History of mechanical obstruction of the intestine or urinary tract
- History of Myocardial infarction
- Uncontrollable Hypertension Defined by a blood pressure reading of 160/100 mmHg or higher
- Organ damage (heart & kidney) and/or transient ischemic attack-cerebral vascular accident as a result of hypertension
- Known past history of coronary artery disease or bradyarrythmia
- Active respiratory disease
- Known history of asthma during lifetime or recent (within 3 months) respiratory infections
- Adrenal insufficiency
- Diagnosed coagulopathy
- Any renal disease or dysfunction
- Potential for pregnancy
- Lactating/nursing females
- Slow-heart beat (HR<45 bpm)
- Lack of mental capacity to give consent
- Use of any antibiotic in the past 7 days
- Use of medications known to affect the respiratory system
- Use of medications known to alter airway caliber
- Concurrent participation in other clinical trials (within 30 days)
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: SCI observational
Individuals with SCI will undergo a one day observation following elective colonoscopy and placement of the colonic catheter.
Investigators will be monitoring colonic motility during a "typical" day (eating, sleeping, mobility, etc.).
|
|
Experimental: Able-bodied observational
Able-bodied individuals (non SCI) will undergo a one day observation following elective colonoscopy and placement of the colonic catheter.
Investigators will be monitoring colonic motility during a "typical" day (eating, sleeping, mobility, etc.).
|
|
Active Comparator: SCI drug group
Individuals with SCI will undergo a second day observation following elective colonoscopy and placement of the colonic catheter.
Investigators will be monitoring colonic motility during the transdermal administration of neostigmine and glycopyrrolate.
|
|
Placebo Comparator: SCI placebo group
Individuals with SCI will undergo a second day of observation following elective colonoscopy and placement of the colonic catheter.
Investigators will be monitoring colonic motility during the transdermal administration of normal saline solution (placebo).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
High Amplitude Contractions
Time Frame: 1-2days
|
Monitor changes in High Amplitude Contractions inside the colon during a typical day for SCI and AB patients.
The manometry system will record these changes and allow the investigators to visualize changes during various activities (eating, resting, supine, seated, walking, etc.)
The investigators will also measure changes in contractions during administration of prokinetic agents to promote bowel evacuations
|
1-2days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Mark Korsten, MD, James J. Peters Veterans Affairs Medical Center
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 13, 2015
Primary Completion (Actual)
December 25, 2017
Study Completion (Actual)
December 25, 2018
Study Registration Dates
First Submitted
October 6, 2015
First Submitted That Met QC Criteria
October 9, 2015
First Posted (Estimate)
October 14, 2015
Study Record Updates
Last Update Posted (Actual)
September 28, 2021
Last Update Submitted That Met QC Criteria
September 22, 2021
Last Verified
September 1, 2021
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Muscarinic Antagonists
- Cholinergic Antagonists
- Cholinergic Agents
- Enzyme Inhibitors
- Adjuvants, Anesthesia
- Cholinesterase Inhibitors
- Parasympathomimetics
- Glycopyrrolate
- Neostigmine
Other Study ID Numbers
- KOR-15-026
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
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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