Functional Dyspepsia
Conditions
Brief summary
After a thorough baseline evaluation, functional dyspepsia (FD) patients will be exposed to nutrients while undergoing confocal laser endomicroscopy (CLE). Patients presenting an acute mucosal reaction upon nutrient exposure will be instructed to exclude their respective trigger nutrient or a nutrient without mucosal reaction (=sham diet) from their diet for 4 weeks in a randomized, blinded crossover fashion. The aim of the trial is to assess the symptomatic response to the targeted diet and further elucidate mechanisms underlying the acute mucosal reactions observed in CLE upon nutrient exposure.
Interventions
OTHERReal diet
Diet excluding either trigger nutrient in a blinded crossover fashion (CLE positive individuals with identified trigger)
OTHERSham diet
Diet excluding either sham nutrient in a blinded crossover fashion (CLE positive individuals with identified trigger) or wheat and soy in a blinded crossover fashion (CLE negative individuals without identified trigger)
OTHERWheat exclusion diet
Diet excluding wheat in a blinded crossover fashion (CLE negative individuals without identified trigger)
OTHERSoy exclusion diet
Diet excluding soy in a blinded crossover fashion (CLE negative individuals without identified trigger)
Sponsors
Universitaire Ziekenhuizen KU Leuven
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 18-70 y/o (70 years included) * Male or female subjects * FD (PDS, EPS or overlap) according to Rome IV criteria * Provide written informed consent to participate in the study * Women of child-bearing potential agree to apply a highly effective method of birth control during the entire duration of the trial. Highly effective birth control is defined as those which result in a low failure rate (i.e., less than 1% per year) when used constantly and correctly such as implants, injectables, combined oral contraceptive method, or some intrauterine devices (IUDs), sexual abstinence, or vasectomized partner. Women of non-childbearing potential may be included if surgically sterile (tubal ligation or hysterectomy) or postmenopausal with at least 2 year without spontaneous menses. * Subjects who are capable to understand the study and the questionnaires, and to comply with the study requirements.
Exclusion criteria
* Pregnant or breastfeeding women * History of major surgery of the gastrointestinal tract (cholecystectomy and uncomplicated appendectomy are allowed) * Symptoms predominantly associated with irritable bowel syndrome or gastro-esophageal reflux disease * IgE-mediated food allergies identified by immunocaps blood tests * Known underlying organic gastrointestinal disease * Current use of NSAIDs, proton-pump inhibitors, systemic histamine-receptor antagonists, mast cell stabilizers, corticosteroids, opioids (need to be stopped at least 2 weeks). Use of antibiotics in the past 6 weeks. * Allergy to Fluorescein or Propofol * Known celiac disease * Following a diet, interfering with the study diet in opinion to the investigators
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Responder rates in targeted diet vs sham diet | After 4 weeks of dietary intervention | Response defined by an improvement of minimum 0.5 points on the LPDS scale |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Baseline duodenal transepithelial electrical resistance between groups | At baseline | Differences in baseline permeability measures (TEER and flux, measured with ussing chambers on duodenal biopsies) between CLE positive and negative patients and healthy volunteers using Ussing chambers |
| Baseline duodenal flux of horse-radish peroxidase between groups | At baseline | Differences in baseline permeability measures (flux, measured with ussing chambers on duodenal biopsies) between CLE positive and negative patients and healthy volunteers using Ussing chambers |
| Evolution of duodenal flux of horse-radish peroxidase between dietary interventions | Baseline and after 4 weeks of diet | Differences in permeability measures (HRP flux, measured with ussing chambers on duodenal biopsies) between dietary interventions (i.e. verum, sham, wheat and soy) during the dietary interventions using urinary Lactulose/Mannitol/Sucralose ratio |
| Evolution of duodenal transepithelial electrical resistance between dietary interventions | Baseline and after 4 weeks of diet | Differences in permeability measures (TEER, measured with ussing chambers on duodenal biopsies) between dietary interventions (i.e. verum, sham, wheat and soy) during the dietary interventions using urinary Lactulose/Mannitol/Sucralose ratio |
| Baseline mucosal immune cell composition between groups | Baseline | Differences in baseline mucosal mast-cell and eosinophil counts between CLE positive and negative patients |
Countries
Belgium
Contacts
Primary ContactJolien Schol, MD
Outcome results
None listed