Irritable Bowel Syndrome
Conditions
Brief summary
Irritable bowel syndrome (IBS) is one of the most common chronic diseases of the gut-brain axis. The underlying pathophysiology is multifactorial, poorly understood and differs between the subtypes: constipation-dominant IBS, diarrhea-dominant IBS, mixed IBS, and unspecified IBS. Although it is considered a motility disorder, no uniform motility patterns have been found in IBS patients and no link has yet been found between the motility patterns and the typical complaints such as nausea, fullness, cramps and flatulence. These symptoms are often diagnosed after a meal and research has shown that especially fermentable oligo, di, monosaccharides and polyols (FODMAPs) give rise to symptoms. Many studies have tested the effect of these FODMAPs after oral administration, but little is known about their direct effect on the colon. In this double-blind cross-over study, 15 healthy volunteers are subjected to 3 colonoscopies in which a catheter is placed to measure the pressures in the large intestine and to administer the dissolved FODMAPs. Volunteers will follow a diet low in fiber and FODMAPs 3 days before each study visit. In addition, they will have to record their daily bowel movements during the week of their study visit and fill in 2 short questionnaires on the day of the study visit regarding their gastrointestinal complaints. There will be at least 2 weeks between the 3 study visits to avoid any overlap between the FODMAPs.
Interventions
DIETARY_SUPPLEMENTFermentable Oligo-, Di- Monosaccharides And Polyols (FODMAPs)
A FODMAP solution of 200 mL will be infused in the colon for over 20 min. via the lumen of the solid-state catheter for high-resolution colonic manometry.
Sponsors
University of Auckland, New Zealand
Universitaire Ziekenhuizen KU Leuven
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
DOUBLE (Subject, Investigator)
Masking description
Both the investigator and the participants will be blinded, which means that they will not know which of the 3 FODMAPs is administered
Intervention model description
Mannitol, fructans and fructose will be intracolonically administered on 3 different intervestigation days with at least 2 weeks between each investigation day to avoid overlap of the different FODMAPs and to allow the colon to return to its original state
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
Yes
Inclusion criteria
* Subjects should 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 years without spontaneous menses. * Subjects who are capable to understand the study and the questionnaires, and to comply with the study requirements. * Healthy volunteers should consider themselves healthy and should not be medically examined
Exclusion criteria
* History of major surgery of the gastrointestinal tract (appendectomy, hemorrhoidectomy, or polypectomy greater than 3 months post-surgery are allowed). * Known underlying organic gastrointestinal disease, including intestinal obstruction, ileus, intestinal perforation, severe inflammatory disorder like ulcerative colitis, Crohn's disease or toxic megacolon * Diabetes mellitus types 1 and 2 * Concomitant Kidney or Liver disease, Biliary obstruction * Decreased cardiac -or respiratory function * Pregnant or breastfeeding women * Use of antibiotics in the past month * History of skin allergies or a history of extreme sensitivity to cosmetics or lotions * Fragile skin vulnerable to skin tears. * Damaged epigastric skin (open wounds, rash, inflammation) * Subjects who are unable to remain in a relaxed reclined position for the test duration * Subject has received an investigational drug or used an investigational medical device within 30 days prior to randomization, or is currently enrolled in an investigational study. * The use of following drugs 1 month prior to inclusion and during the whole study duration: laxatives, opioids, anti-acids, anticholinergics/antispasmodics, anticonvulsants, antidepressants, diuretics, antihypertensives, antipsychotics, calcium channel blockers, bile acid sequestrants, iron supplements, anticoagulants, HIV protease inhibitors (saquinavir, lopinavir), atorvastatine, negazodone, efavirenz, Sint-janskruid (CYP3A4 inducers)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| colonic motility | through study completion, an average of 1 year | evaluation of (high amplitude) propagating contractions, simultaneous pressure waves at 3 predefined timepoints: upon awakening, after FODMAP infusion and postprandially |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| stool form based on the bristol stool chart | through study completion, an average of 1 year | stool form differences will be evaluated during the week of the investigation (3 days before the study visit, on the day of investigation, and 3 days after the study visit) |
| IBS-SSS and IBS-Qol | through study completion, an average of 1 year | IBS symptom severity and influence of quality of life will be assessed at each investigation and compared between the 3 study arms. |
| abdominal symptoms | through study completion, an average of 1 year | symptoms will be registered every 15minutes during the evaluation of the colonic motility |
| colonic motor patterns by means of high resolution electrocolonography | through study completion, an average of 1 year | simultaneous evaluation of colonic motor patterns with high-resolution colonic manometry and high-resolution electrocolonography |
| validation of the high-resolution electrocolonography | through study completion, an average of 1 year | evaluation of the high-resolution electronography als a non-invasive tool for the measurement of colonic motility |
| microbiome | through study completion, an average of 1 year | a stool sample will be taken before the first study visit to evaluate the microbial composition |
Countries
Belgium
Outcome results
None listed