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Gut Imaging for Function & Transit in Cystic Fibrosis Study 1

A Case-Control, Observational Study of the Postprandial Changes in Magnetic Resonance Imaging Parameters of Gastrointestinal Function and Transit in People With Cystic Fibrosis

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT03566550
Acronym
GIFT-CF1
Enrollment
25
Registered
2018-06-25
Start date
2018-09-04
Completion date
2019-02-20
Last updated
2021-07-21

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Cystic Fibrosis

Brief summary

Many people with Cystic Fibrosis (CF) are troubled by symptoms from their stomach and bowels: their gastrointestinal (GI) tract. Symptoms affect quality of life and can also reduce people's ability to digest enough calories to remain healthy, leaving them undernourished and less able to deal with other health problems such as infection. Clinical tests to assess bowel function are limited. Many tests involve inserting a sensor or camera into the bowel, so they are not suitable for long periods, and can be uncomfortable. In Nottingham the investigators have developed imaging scans which can assess how someone's digestion works without any invasive device. The type of scanning the investigators use is called Magnetic Resonance Imaging, or MRI. The purpose of this study is to see if those scanning methods can be used in people with CF to understand their digestion and any problems they have.

Detailed description

This is a small pilot study to establish that differences in digestion between people with and without CF can be quantified by repeated MR scans in fasted participants in response to standardised meals. Participants will complete questionnaires on gastrointestinal function and symptoms: the PAC-SYM questionnaire, validated to assess symptom burden in adults with chronic constipation; and the CF abdomen questionnaire, developed in German for use in young people and adults with cystic fibrosis. After this, participants only need to attend one study day at the Sir Peter Mansfield Imaging Centre. On this day they will be asked to withhold any medicines specifically targeted to alter bowel habit. This shall include laxatives but not enzyme replacement therapy. They should attend on the study day having fasted since waking, other than water for essential medicines. They will have their first MRI scan fasted. After the scan they will eat a standard test meal, and be scanned again first at half hour, then hour intervals until six hours after the first meal. The final scan will constitute the end of the study for each participant. Each session in the MRI scanner will last around 15 minutes. After each scan they will complete a validated rating scale for any current symptoms: the Gastrointestinal Symptom Rating Scale (GSRS).In between scans, participants will have access to a lounge with wifi and a television. Infection control requirements mean that the investigators are unable to scan more than one patient with CF on a single day. Patient scans will alternate with those of a Control participant. The investigators will aim to frequency match Controls with Patients for age and gender.

Interventions

DIAGNOSTIC_TESTMRI scans

Repeated MRI scans imaging digestion of standard meals

Sponsors

Nottingham University Hospitals NHS Trust
Lead SponsorOTHER

Study design

Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL

Eligibility

Sex/Gender
ALL
Age
12 Years to 40 Years
Healthy volunteers
Yes

Inclusion criteria

* Age 12 - 40 years * Capacity to consent, or to understand the requirements of the study where parental consent is needed * PATIENTS: confirmed diagnosis of Cystic Fibrosis, either by sweat test or genetic testing; to reduce heterogeneity, we will only enrol homozygous CF patients with the most common CFTR mutation, p.Phe508del * CONTROLS: no clinical evidence or suspicion of Cystic Fibrosis

Exclusion criteria

• Measurement of Forced Expiratory Volume in 1 second (FEV1) of \<40% predicted using Global Lung Initiative criteria, according to clinical records * Contra-indication to MRI scanning, such as embedded metal, pacemaker * Unable to stop medications directly prescribed to alter bowel habit, such as laxatives of anti-diarrhoeals, on the study day * Previous resection of any part of the gastro-intestinal tract apart from appendicectomy or cholecystectomy. Surgical relief of distal ileal obstruction syndrome or neonatal ileus will be permitted unless clinical records show excision of intestine \>20cm in length. * Intestinal stoma * Diagnosis of inflammatory bowel disease or coeliac disease confirmed by biopsy * Gastrointestinal malignancy * Unable to comply with dietary restrictions required for the study

Design outcomes

Primary

MeasureTime frameDescription
Orocaecal Transit Time1 day of scanningtime taken after eating for ingested food to be identifiable in the caecum on MRI

Secondary

MeasureTime frameDescription
Gastric Half Emptying Times1 day of scanningvolume of stomach at each time point of digestion to measure speed of gastric emptying (time taken for half the gastric contents to be emptied)
Small Bowel Water Content (Corrected for Body Surface Area)1 day of scanningvolume of water content in small bowel representing secretions (area under the curve - timepoints at baseline then 0,30,60,90,120,150,180,240,300,360 minutes)
Colonic Volume (Corrected for Body Surface Area)1 day of scanningvolume of colon representing ease of chyme passage through colon (area under the curve - timepoints at baseline then 0,30,60,90,120,150,180,240,300,360 minutes)
Gastrointestinal Symptoms1 day of scanninggastrointestinal symptoms as measured by questionnaires to monitor relationship with outcomes measured by MRI. Scale of the CFAbd-score ranges from 0-100. A low score indicates fewer gastrointestinal symptoms whilst a higher score indicates more severe and frequent gastrointestinal symptoms.

Other

MeasureTime frameDescription
T1 Relaxation Time of Ascending Colon Chyme1 day of scanningAn approximate measure of water content in chyme present in the ascending colon
Fat Fraction of the Ascending Colon Chyme1 day of scanningA measure of fat content in chyme present in the ascending colon

Countries

United Kingdom

Participant flow

Recruitment details

51 CF patients were eligible. CF patients were approached in order of their hospital attendance and the first 12 to provide written consent were enroled into the study. 13 declined to participate and 2 withdrew consent as they did not like the standardised meals or MRI. 12 CF patients and 12 controls completed the protocol without any adverse events. 1 further control was withdrawn and replaced as the participant was unable to complete the first standardised meal and the remaining 10 MRI scans.

Participants by arm

ArmCount
Cystic Fibrosis
people with cystic fibrosis MRI scans: Repeated MRI scans imaging digestion of standard meals
12
Control
people without cystic fibrosis MRI scans: Repeated MRI scans imaging digestion of standard meals
12
Total24

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyWithdrawal by Subject01

Baseline characteristics

CharacteristicCystic FibrosisControlTotal
Age, Categorical
<=18 years
5 Participants5 Participants10 Participants
Age, Categorical
>=65 years
0 Participants0 Participants0 Participants
Age, Categorical
Between 18 and 65 years
7 Participants7 Participants14 Participants
Height (cm)166 cm166 cm166 cm
Race and Ethnicity Not Collected0 Participants
Region of Enrollment
United Kingdom
12 participants12 participants24 participants
Sex: Female, Male
Female
5 Participants5 Participants10 Participants
Sex: Female, Male
Male
7 Participants7 Participants14 Participants
Weight (kg)56 kg62 kg59 kg

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 120 / 12
other
Total, other adverse events
0 / 120 / 12
serious
Total, serious adverse events
0 / 120 / 12

Outcome results

Primary

Orocaecal Transit Time

time taken after eating for ingested food to be identifiable in the caecum on MRI

Time frame: 1 day of scanning

ArmMeasureValue (MEDIAN)
Cystic FibrosisOrocaecal Transit Time330 minutes
ControlOrocaecal Transit Time210 minutes
p-value: 0.04Log Rank
Secondary

Colonic Volume (Corrected for Body Surface Area)

volume of colon representing ease of chyme passage through colon (area under the curve - timepoints at baseline then 0,30,60,90,120,150,180,240,300,360 minutes)

Time frame: 1 day of scanning

ArmMeasureValue (MEDIAN)
Cystic FibrosisColonic Volume (Corrected for Body Surface Area)186 L.min/m^2
ControlColonic Volume (Corrected for Body Surface Area)123 L.min/m^2
p-value: 0.012Wilcoxon (Mann-Whitney)
Secondary

Gastric Half Emptying Times

volume of stomach at each time point of digestion to measure speed of gastric emptying (time taken for half the gastric contents to be emptied)

Time frame: 1 day of scanning

ArmMeasureValue (MEDIAN)
Cystic FibrosisGastric Half Emptying Times97 minutes
ControlGastric Half Emptying Times80 minutes
p-value: 0.3Wilcoxon (Mann-Whitney)
Secondary

Gastrointestinal Symptoms

gastrointestinal symptoms as measured by questionnaires to monitor relationship with outcomes measured by MRI. Scale of the CFAbd-score ranges from 0-100. A low score indicates fewer gastrointestinal symptoms whilst a higher score indicates more severe and frequent gastrointestinal symptoms.

Time frame: 1 day of scanning

ArmMeasureValue (MEDIAN)
Cystic FibrosisGastrointestinal Symptoms16 CFAbd-Score units
ControlGastrointestinal Symptoms7 CFAbd-Score units
p-value: 0.13Wilcoxon (Mann-Whitney)
Secondary

Small Bowel Water Content (Corrected for Body Surface Area)

volume of water content in small bowel representing secretions (area under the curve - timepoints at baseline then 0,30,60,90,120,150,180,240,300,360 minutes)

Time frame: 1 day of scanning

ArmMeasureValue (MEDIAN)
Cystic FibrosisSmall Bowel Water Content (Corrected for Body Surface Area)62 L.min/m^2
ControlSmall Bowel Water Content (Corrected for Body Surface Area)34 L.min/m^2
p-value: 0.021Wilcoxon (Mann-Whitney)
Other Pre-specified

Fat Fraction of the Ascending Colon Chyme

A measure of fat content in chyme present in the ascending colon

Time frame: 1 day of scanning

Other Pre-specified

T1 Relaxation Time of Ascending Colon Chyme

An approximate measure of water content in chyme present in the ascending colon

Time frame: 1 day of scanning

Source: ClinicalTrials.gov · Data processed: Feb 12, 2026