Impact of Probiotics on Oral Microbiota in Older Adults With Dysphagia

July 28, 2023 updated by: University of Wisconsin, Madison

Impact of Probiotics on Oral Microbiota in Older Adults With Dysphagia at Risk for Pneumonia

The overall purpose of this study is to characterize the effect of probiotics on the oral microbiota in older adults with dysphagia at risk for pneumonia.

Study Overview

Status

Suspended

Conditions

Intervention / Treatment

Detailed Description

The goal of this pilot study is to characterize the effects of probiotics on the oral microbiota in older patients with dysphagia at risk for pneumonia. A total of 20 participants will be recruited from the UW Health Inpatient Swallowing Consult Service. Participants will have a dysphagia diagnosis along with documented aspiration on videofluoroscopy. Each participant will receive a once daily VSL#3 probiotic blend (dissolved in thickened liquid as applicable) for 28 days. A baseline assessment will be completed to collect data on demographics, health history and behaviors, usual diet, level of oral intake, and patient-reported swallow function. Oral swab (buccal mucosa and tongue dorsum) as well as saliva sample collections will be completed. Data on adherence and adverse events will be collected weekly. Bacterial DNA will be extracted from oral samples and 16S rRNA sequencing techniques will be used to identify contents of oral microbiota at baseline, week 2, and week 4. Oral microbial composition will be compared between the time points, and treatment feasibility (recruitment and retention rates) in this population will be evaluated.

Study Type

Interventional

Enrollment (Estimated)

20

Phase

  • Early 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

    • Wisconsin
      • Madison, Wisconsin, United States, 53562
        • University of Wisconsin-Madison

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

63 years to 97 years (Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria

  1. 65 years of age or older
  2. Dysphagia diagnosis based on videofluoroscopic swallow study with observed airway invasion (Penetration-Aspiration Scale score of 3 or higher)
  3. Ability to provide consent
  4. Ability to submit oral samples
  5. Ability to swallow sachet of probiotic (dissolved in thickened liquid, as needed)
  6. Ability to return to UWHC for week 2 and week 4 visits.

Exclusion Criteria

  1. Currently taking antibiotics or probiotics
  2. Actively receiving immunosuppressive therapy
  3. Non-oral feeding with inability to swallow probiotic
  4. diagnosis of head and neck cancer or upper airway disease
  5. prior surgery to the head and neck region that would have affected the muscles of swallowing or the salivary glands
  6. history of chemotherapy or radiation to the head and neck region
  7. severe periodontal disease.
  8. currently pregnant or planning to become pregnant

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: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Probiotic
The treatment will consist of VSL#3, 3 grams (g), taken orally once a day for 4 weeks. The VSL#3 will be delivered in the form of a sachet of freeze-dried powder. Participants will be instructed to mix the sachets with water to consume. Those participants taking thickened liquids will mix the sachet with liquids thickened to the level (nectar versus honey) prescribed by their clinician. In order to facilitate delivery of the probiotic solution throughout the oral cavity, participants will be instructed to swish the solution in the mouth for up to 10 seconds (as tolerated) prior to each swallow.
Probiotics are dietary supplements composed of live microorganisms that are normally found within the human microbiome. Probiotics, specifically Lactobacilli and Streptococcus salivarius, have been shown to alter oral microbial composition and to inhibit oral pathogens that contribute to dental caries and periodontal disease. The probiotic chosen for this study is VSL#3, a blend of 8 strains of bacteria, including Lactobacillus and Streptococcus salivarius. VSL#3 has been well tolerated, with minimal adverse effects. VLS#3 was chosen as the treatment substance for this project due to its successful use in trials examining an array of outcomes and its combination of several strains of bacteria.
Other Names:
  • probiotic

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Oral microbiota profiles- bacterial diversity
Time Frame: Baseline visit, 2 weeks post-enrollment, and 4 weeks post-enrollment
Next generation sequencing will be used to quantify the amount of alpha and beta diversity in samples collected from various locations in the oral cavity (buccal mucosa, dorsum of the tongue, saliva).
Baseline visit, 2 weeks post-enrollment, and 4 weeks post-enrollment

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Eating Assessment Test (EAT-10)
Time Frame: Baseline visit
Patient reported outcome measure for swallowing
Baseline visit
Functional Oral Intake Scale (FOIS) Score
Time Frame: Baseline visit
Scale used to quantify the amount of oral versus non-oral intake
Baseline visit
Kayser-Jones Brief Oral Health Status Examination (BOHSE)
Time Frame: Baseline visit
A valid and reliable scoring instrument developed for use with older adults by non-dental health care providers.
Baseline visit
Change in Resting Swallow Frequency Rate
Time Frame: Baseline visit, 2 weeks post-enrollment, and 4 weeks post-enrollment
We will measure resting swallow frequency using surface electromyography (sEMG).
Baseline visit, 2 weeks post-enrollment, and 4 weeks post-enrollment
Change in Residual Mucosal Saliva (RMS)
Time Frame: Baseline visit, 2 weeks post-enrollment, and 4 weeks post-enrollment
Residual Mucosal Saliva will be collected from the anterior hard palate (AHP), buccal (BUC), anterior tongue (AT), and lower labial (LL) surfaces using SialoPaper strips
Baseline visit, 2 weeks post-enrollment, and 4 weeks post-enrollment
Change in Amount of Saliva Produced
Time Frame: Baseline visit, 2 weeks post-enrollment, and 4 weeks post-enrollment
Salivary flow rate (ml/minute) will be calculated under unstimulated and stimulated saliva collection conditions.
Baseline visit, 2 weeks post-enrollment, and 4 weeks post-enrollment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

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)

August 13, 2018

Primary Completion (Estimated)

March 1, 2024

Study Completion (Estimated)

March 1, 2024

Study Registration Dates

First Submitted

August 21, 2018

First Submitted That Met QC Criteria

September 21, 2018

First Posted (Actual)

September 24, 2018

Study Record Updates

Last Update Posted (Actual)

August 1, 2023

Last Update Submitted That Met QC Criteria

July 28, 2023

Last Verified

July 1, 2023

More Information

Terms related to this study

Other Study ID Numbers

  • 2018-0428
  • A534255 (Other Identifier: UW Madison)
  • SMPH/MEDICINE/GER-AD DEV (Other Identifier: UW Madison)
  • Protocol Version 3/11/2019 (Other Identifier: UW Madison)

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

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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