- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05836155
Evidence Based Probiotic Therapy of Proton Pump Inhibitor Induced Dysbiosis (EBP)
Evidence Based Probiotic Therapy of Proton Pump Inhibitor Induced Gastrointestinal Discomfort and Oralization of the Gut Microbiome: An Open-label Pilot Single-arm Trial
Study Overview
Detailed Description
With the emergence of high throughput sequencing techniques, researchers obtained the necessary tools to launch in-depth investigations into the structure and function of the intestinal microbiome. For the first time, it was possible to describe the influence of genetics, environment, nutrition and diseases on the microbiome and identify major determinants. One of the most prominent influencing factors on the composition of the microbiome is the use of proton pump inhibitors (PPI), in the general population as well as in chronic diseases, such as liver cirrhosis.
Proton pump inhibitors are used to treat gastric acid related diseases. They drastically reduce the secretion of gastric acid and thereby increase the gastric pH. The reduction of gastric acid production, however, allows acid-sensitive food-borne and oral bacteria to pass the stomach unharmed and colonize the more distal parts of the intestine. In addition, PPI use creates less favorable conditions for typical gut commensals and reduces the microbial diversity in the intestine. These alterations in the microbiome can be linked to PPI side effects, such as gastrointestinal symptoms (e.g., abdominal discomfort, bloating, constipation or diarrhea) and an increased risk for enteral infections. In patients with liver cirrhosis, PPI-induced changes in the microbiome, namely Streptococcus salivarius and Veillonella parvula - two oral bacteria, are linked to intestinal inflammation and gut permeability and predict a higher risk of complications and a higher three-year liver related mortality. These are considerable risks that need to be weighed against the benefits of the therapy. Reduction of PPI use to cases with a clear indication is one important measure to reduce potential harm of the treatment. However, many patients require long-term treatment, e.g. for gastroesophageal reflux disease or to prevent gastrointestinal bleeding when drugs with a high risk of bleeding are used (such as thrombocyte aggregation inhibitors and oral anticoagulation). Therefore, strategies to reduce oralization and thereby symptoms and negative consequences of PPI are necessary.
One possibility to change the composition of the gut microbiome is the use of probiotic bacteria. Probiotics are live microorganisms that have been demonstrated to alter the gut microbiome and exhibit positive effects on numerous gastrointestinal complaints, strengthen the gut barrier and reduce inflammation parameters. The investigators previously showed in a pilot study that a multispecies probiotic was able to improve gut permeability biomarkers in patients with long-term PPI therapy as well as gastrointestinal symptoms. However, this product was not able to efficiently reverse oralization. Therefore, the investigators conducted a series of experiments, including direct and indirect pathogen inhibition tests to identify probiotic strains that are capable of inhibiting the growth of Streptococcus salivarius and Veillonella parvula in vitro to design an evidence based probiotic mixture. The investigators screened 43 QPS (Qualified presumption of safety, granted by the European Food Safety Authority) certified probiotic strains and identified 5 strains as potential therapeutic agents to prevent/treat PPI induced oralization (unpublished data).
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Vanessa Stadlbauer, Association Prof Dr
- Phone Number: 385 0043 316
- Email: vanessa.stadlbauer@medunigraz.at
Study Locations
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-
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Graz, Austria
- Recruiting
- Medical University Graz
-
Contact:
- Vanessa Stadlbauer-Köllner, MD
- Phone Number: 82282 0043 316 385
- Email: vanessa.stadlbauer@medunigraz.at
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age >18;
- Signed Informed Consent;
- PPI intake for at least 3 months;
- Willing to accept use of all encoded data, including publication, and the confidential use and storage of all data for at least 15 years; Exclusion criteria
- Diagnosed with a gastrointestinal infection within 4 weeks prior to screening; Severe gastrointestinal disorders (e.g. inflammatory bowel diseases)
- Received any of the following products/medication prior to screening: systemic antibiotics, prokinetics, prebiotic supplements, probiotic supplements within 4 weeks prior to screening;
- Concomitant diseases or other circumstances that suggest that the patients are not eligible for participation in the study
Study Plan
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: Intervention
The study product contains Lactobacillus acidophilus W53, Lactobacillus acidophilus W55, Lactobacillus casei W56, Lactobacillus plantarum W1, Lactobacillus plantarum W21, Lactobacillus rhamnosus W71, and Pediococcus acidilactici W143.
|
multispecies probiotic
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in overall symptom score
Time Frame: 3 months
|
Gastrointestinal quality of life index (GIQLI)
|
3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Other dimension of gastrointestinal quality of life
Time Frame: 3 months
|
Gastrointestinal quality of life index (GIQLI)
|
3 months
|
Composition of the faecal metabolome
Time Frame: 3 months
|
NMR metabolomics
|
3 months
|
Zonulin
Time Frame: 3 months
|
measurement of faecal zonulin
|
3 months
|
Calprotectin
Time Frame: 3 months
|
measurement of faecal calprotectin
|
3 months
|
Diaminooxidase
Time Frame: 3 months
|
measurement of serum diaminooxidase
|
3 months
|
lipopolysaccharide binding protein
Time Frame: 3 months
|
measurement of serumlipopolysaccharide binding protein
|
3 months
|
soluble CD14
Time Frame: 3 months
|
measurement of serum soluble CD14
|
3 months
|
Veillonella parvula
Time Frame: 3 months
|
measurement of stool Veillonella parvula gene abundance
|
3 months
|
Streptococcus salivarius
Time Frame: 3 months
|
measurement of stool Streptococcus salivarius gene abundance
|
3 months
|
Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- 35-175 ex 22/23
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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