- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05524844
The Microbiome, Bile Acids, and Notch in Barrett's Esophagus (BE)
August 29, 2023 updated by: Julian A Abrams, MD, Columbia University
The Role of the Microbiome and Notch Signaling in Esophageal Adenocarcinoma
The purpose of this study is to prospectively collect and analyze clinical data and biospecimens from a cohort of 100 patients without BE (20), with non-dysplastic BE (40), or with BE and high grade dysplasia (HGD) or EAC (40).
The investigators will enroll 80 patients scheduled for upper endoscopy for clinical purposes, with a history of histologically confirmed BE (2 cm length); 40 with no history of dysplasia, and 40 with HGD or EAC.
The investigators will also enroll 20 non-BE controls undergoing endoscopy for any indication who are on stable dose proton-pump inhibitors (PPI) for the past month.
PPI therapy is standard of care for BE patients.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
The incidence of esophageal adenocarcinoma (EAC) has risen 10-fold over the past half century and continues to have a dismal prognosis.
Known risk factors for EAC do not adequately explain these incidence trends; the rise in EAC cases began a decade before increases in the prevalence of both gastro-esophageal reflux disease and obesity.
Over the past 50+ years, dramatic changes in the bacterial composition (or microbiome) of the upper gastrointestinal tract have also occurred.
While prior work has shown correlations between the microbiome, BE, and EAC, there is a critical knowledge gap on mechanisms by which bacteria interact with the esophagus and potentially promote cancer.
The investigators hypothesize that increased levels of the certain bile acids in gastroesophageal reflux fluid cause changes that lead to increased interaction between bacteria and the esophagus, which may promote the development of esophageal adenocarcinoma (EAC).
The investigators will carry out a case-control study of patients with and without BE, dysplasia, or EAC.
The investigators will focus on deoxycholic acid in gastro-esophageal refluxate and its association with Notch signaling in tissue and bacterial composition.
The microbiome represents a novel and potentially modifiable risk factor for the development of BE and EAC.
Elucidation of microbiome features and mechanisms that promote the development of EAC is a critical step that will lead to subsequent trials of antibiotics, probiotics, and other interventions targeted to altering the microbiome, with the goal of lowering the risk of this highly lethal malignancy.
Study Type
Observational
Enrollment (Estimated)
100
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Julian Abrams, MD
- Phone Number: 2128059541
- Email: ja660@cumc.columbia.edu
Study Contact Backup
- Name: Katharine Boyce, RN
- Email: kb3217@cumc.columbia.edu
Study Locations
-
-
New York
-
New York, New York, United States, 10032
- Recruiting
- Columbia University Irving Medical Center
-
Contact:
- Julian Abrams, MD
- Phone Number: 212-305-1909
- Email: ja660@cumc.columbia.edu
-
New York, New York, United States, 10065
- Recruiting
- Weill Cornell Medical Center
-
Contact:
- Felice Schnoll-Sussman, MD
- Phone Number: 646-962-4463
- Email: fhs2001@med.cornell.edu
-
-
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 and older (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Sampling Method
Non-Probability Sample
Study Population
Study population will be based on the population of BE and EAC as well as the demographics of those who undergo upper endoscopy for other indications (the control population) at Columbia and Cornell, together with data drawn from numerous prior studies in our BE population.
Description
Inclusion Criteria:
All subjects:
- Scheduled for an upper endoscopy
- Taking stable dose of a proton pump inhibitor at least once daily for 1 months prior to enrollment
- Eighteen years of age or older
- Able to give informed consent
Barrett's esophagus subjects only:
- Histologically confirmed BE (defined as endoscopically- suspected BE with intestinal metaplasia with goblet cells on esophageal biopsies)
- Maximal BE length ≥ 2 cm (Prague criteria: any C, M≥2)
Exclusion Criteria:
All subjects:
- History of head and neck cancer or esophageal or gastric cancer (except esophageal intramucosal adenocarcinoma)
- History of esophageal or gastric surgery
- Use of antibiotics or immunosuppressants within 1 month prior to endoscopy
Barrett's esophagus subjects only:
• History of prior endoscopic therapy for BE, except a history of prior endoscopic mucosal resection (EMR) of focal lesions withoutsubsequent ablative therapy is permitted
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
- Observational Models: Cohort
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Control
Non-BE controls undergoing endoscopy for any indication who are on stable dose Proton Pump Inhibitors for the past month.
|
Saliva, gastric aspirate, and esophageal brushings and biopsies.
Results from standard of care endoscopy (scheduled separate of study)
Diet History Questionnaire (II)
|
Barrett's Esophagus
Patients scheduled for upper endoscopy for clinical purposes, with a history of histologically confirmed Barrett's esophagus (2 cm length); 40 with no history of dysplasia, and 40 with high grade dysplasia or esophageal adenocarcinoma.
|
Saliva, gastric aspirate, and esophageal brushings and biopsies.
Results from standard of care endoscopy (scheduled separate of study)
Diet History Questionnaire (II)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Concentration of Deoxycholic Acid (DCA)
Time Frame: 2 years
|
To determine whether refluxate deoxycholic acid (DCA) is associated with increased Notch signaling in the development of esophageal adenocarcinoma (EAC), the investigators will calculate Pearson's correlation coefficients to assess within individual correlations between DCA and NOTCH3 gene expression.
|
2 years
|
Correlation between Enterobacteriaceae (from 16S) and NOTCH3 expression in BE tissue.
Time Frame: 2 years
|
The within-individual correlation will be calculated.
|
2 years
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Julian Abrams, MD, Columbia University
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)
February 9, 2021
Primary Completion (Estimated)
May 1, 2024
Study Completion (Estimated)
December 1, 2024
Study Registration Dates
First Submitted
August 30, 2022
First Submitted That Met QC Criteria
August 30, 2022
First Posted (Actual)
September 1, 2022
Study Record Updates
Last Update Posted (Actual)
August 30, 2023
Last Update Submitted That Met QC Criteria
August 29, 2023
Last Verified
August 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Carcinoma
- Neoplasms, Glandular and Epithelial
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Head and Neck Neoplasms
- Esophageal Diseases
- Precancerous Conditions
- Adenocarcinoma
- Esophageal Neoplasms
- Barrett Esophagus
Other Study ID Numbers
- AAAT2456
- R01CA255298 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
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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