- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03660176
Effects of Butyrate Enemas on Postoperative Intestinal Mobility Disorders in Hirschsprung's Disease (Buty-Hirsch)
Effects of Butyrate Enemas on Postoperative Intestinal Mobility Disorders in Hirschsprung's
Hirschsprung's disease (HD) is a rare disease defined as a congenital absence of enteric ganglia, resulting usually in neonatal bowel obstruction. The current treatment is the operative removal of the aganglionic bowel and anastomosis to the ganglionic zone considered as 'healthy'. However, postoperative course remains unpredictable.
Functional intestinal disorders are present in up to 45% of patients and can occur in the immediate postoperative period or few weeks/years later.
Until now, there are neither predictive factors of postoperative digestive complications nor established treatment for postoperative dysmotility in HD. Abnormalities in enteric nervous system (ENS) phenotype and functions in the 'healthy' ganglionic segment are increasingly suspected to be directly responsible for postoperative intestinal dysfunctions in HD. Therefore, approaches aimed at restoring the nitrergic phenotype could be of major therapeutical interest. Among targets regulating the nitrergic phenotype of ENS are the microbiota and/or derived metabolites. Indeed preclinical animal models deficient in bacterial sensing molecules have a loss of nitrergic neurons and reduced colonic transit. Conversely, microbiota transfer to newborn germ-free mice restored colonic transit time. Alternatively the investigators has shown that bacterial metabolites such as short-chain fatty acids, in particular butyrate, can increase nitrergic phenotype and enhance colonic motility in a gut immaturity animal model. Therefore the investigators hypothesize preoperative butyrate enema will reduce postoperative intestinal complications at short-term and medium/long-term.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: ANNE DARIEL, MD
- Phone Number: +33 491964885
- Email: Anne.DARIEL@ap-hm.fr
Study Locations
-
-
Paca
-
Marseille, Paca, France, 13354
- Assistance Publique des Hôpitaux de Marseille
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Newborn with a diagnosis of Hirschsprung's disease the 2 first months of life,
- Born at or after 35 weeks of gestation (37 weeks of amenorrhea),
- With a short-segment Hirschsprung's disease limited to the rectum and/or sigmoid colon diagnosed on rectal biopsy with established pathological criteria (absence of ganglionic cells +/- hypertrophic extrinsic nerve fibres) (Kapur, Sem Ped Surg 2009),
- Managed successfully with colonic decompressions/irrigations before curative surgery (usually performed 2-3 times a day),
- Uncomplicated form (without enterocolitis and/or diverting colostomy),
- Curative surgery and follow-up in one of the included centres,
- With consent of the 2 parents or legal(s) representative(s),
- Absence of severe or lethal associated malformations,
- Affiliation with the French social security system.
Exclusion Criteria:
- - Long segment Hirschsprung's disease prior to the junction between the left colon and the sigmoid colon,
- Hirschsprung's disease not managed successfully with colonic decompressions/irrigations and requiring a diverting colostomy before the curative surgery,
- Hirschsprung-associated enterocolitis occurring before the randomization,
- Severe or lethal associated malformation, including Down syndrome,
- Intestinal associated malformations (intestinal atresia, gastroschisis, omphalocele, intestinal malrotation and volvulus),
- Any pathological condition that can modify intestinal motility or intestinal transit time (cystic fibrosis, hypothyroidism),
- Refusal of parent(s) or legal representative(s).
- Patients under curatorship or tutorship
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: routine management
Children in the control group receive no additional treatment
|
the colonic irrigations
|
EXPERIMENTAL: EXP GROUP
children receiving butyrate enemas + routine management butyrate enemas every day before Curative surgery
|
10ml/kg volume of butyrate enemas in addition to the colonic irrigations
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The time to recovery of bowel function after the curative surgery. A 25% decrease of the time to recovery of bowel function in the experimental group as compared to the control group will be considered as clinically effective.
Time Frame: 5 YEARS
|
The recovery of bowel function is defined as follows:
The time to recovery of bowel function will be measured in hours from the end of the curative surgery. |
5 YEARS
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The red carmin total transit time will be measured before the surgery
Time Frame: 5 YEARS
|
After randomisation (and before the first butyrate enema) Before the curative surgery
|
5 YEARS
|
The postoperative medium/long-term efficacy of butyrate enemas
Time Frame: 5 YEARS
|
Postoperative functional intestinal obstructive symptoms evaluated at each medical appointment The stool consistency evaluated using the validated 'Amsterdam' infant stool form scale at each medical appointment.
|
5 YEARS
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2018-02
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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