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A Double-blind randomised placebo-controlled pilot study as well as a reversed translational part To investigate whether two faecal transplantations from either allogeneic (healthy) or autologous (own) donor, administered through a nasoduodenal tube, has beneficial effects on irritable bowel syndrome (IBS) symptoms such as abdominal pain frequency and severity. Secondary objective is to study microbiota changes in faeces samples.
Full description
Irritable bowel syndrome (IBS) is a chronic disorder characterized by abdominal pain or discomfort associated with a change in stool form or frequency, in the absence of a biochemical or structural explanation for these symptoms. The prevalence of IBS in the general adult population is 9.8-12.8%, which is in accordance to the prevalence of IBS in children and adolescents (6.2%-11.9%). Patients with IBS report a decreased quality of life, high work or school absence, and are more at risk than healthy controls of developing depressive and anxiety disorders. Consequently, the healthcare costs are substantial; annual costs of care for adults with IBS in the USA are estimated to be over $20 billion. Total annual costs per paediatric IBS patient in the Netherlands are estimated to be €2500. Although the pathophysiology of IBS has not been fully elucidated, pathophysiological abnormal gastrointestinal motility, visceral hypersensitivity, altered brain-gut function, low-grade inflammation, psychosocial disturbance and intestinal microbiota characteristics have been proposed to contribute to the pathophysiology. Current treatment focuses on abnormal gastrointestinal motility, altered brain-gut function and psychosocial disturbances. However, a significant amount of IBS patients has remaining symptoms, despite these treatment regimens. These patients are considered to be therapy-resistant, also called refractory. Treatment focusing on other components of the underlying pathophysiology, such as the intestinal microbiota, might therefore lead to new therapeutic successes in this group of patients. In this light, being able to modify the intestinal microbiota inrefractory IBS patients could have beneficial effects on symptoms. Faecal transplantation, a relatively new treatment regimen that enables the modification of the microbiome, has been shown to be highly effective in treating Clostridium difficile infections and also yielded promising results in patients with other diseases such as diabetes.
Objective: To investigate whether two faecal transplantations from either allogeneic (healthy) or autologous (own) donor, administered through a nasoduodenal tube, has beneficial effects on irritable bowel syndrome (IBS) symptoms such as abdominal pain frequency and severity. Secondary objective is to study microbiota changes in faeces samples.
Study design: Double-blind randomised placebo-controlled pilot study as well as a reversed translational part.
Study Population: Patients with refractory IBS, defined as a failure to improve after standard medical treatment, at least 6 sessions of a psychological therapy and absence of response to at least 1 pharmacological agent (aged 16-21 years, male/female, no concomitant medication, non-smoking), will be recruited by their (paediatric) gastroenterologist at the Academic Medical Centre (Amsterdam, the Netherlands) and patients from other hospitals will be enrolled. Donors: relatives or volunteers will serve as faeces donor, potential donors will be thoroughly screened.
Treatment: After bowel lavage with Klean-Prep, patients will be treated with faecal transplantation at t=0 and t=6 weeks, processed for duodenal tube infusion. Faeces will be collected from a healthy donor (allogeneic) as well as the patient him/herself (autologous), in which their own faeces will be used as a placebo.
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Inclusion criteria
Patients
Donors
Exclusion criteria
Patients
Donors
Abnormal bowel motions, abdominal complaints or symptoms indicative of irritable bowel syndrome
An extensive travel behaviour
Unsafe sex practice (questionnaire)
Use of any medication including PPI
Antibiotic treatment in the past 12 weeks
A positive history/clinical evidence for inflammatory bowel disease (Crohns disease or ulcerative colitis) or other gastrointestinal diseases, including chronic diarrhoea or chronic constipation
A positive history/clinical evidence for autoimmune disease (type 1 diabetes, Hashimoto hypothyroidism, Graves hyperthyroidism, rheumatoid arthritis, celiac disease) and/or patients receiving immunosuppressive medications
History of or present known malignant disease and/or patients who are receiving systemic anti-neoplastic agents
Known psychiatric disease (depression, schizophrenia, autism, Asperger's syndrome)
Known chronic neurological/neurodegenerative disease (e.g. Parkinson's disease, multiple sclerosis)
Predisposing factors for potential transmittable diseases (e.g. regular sexual contact with prostitutes/promiscuity)
Positive blood tests for the presence of: HIV, HTLV, lues, Strongyloides, amoebiasis
Active hepatitis A, B-, C- or E-virus infection or known exposure within recent 12 months, acute infection with cytomegalovirus (CMV) or Epstein-Barr virus (EBV)
Positive faecal tests for the presence of:
If a donor turns out positive for only 1 of the above mentioned non-pathogenic parasites, inclusion is acceptable
o Parasitic worm eggs, larvae, protozoan cysts and oocysts
Chronic pain syndromes (e.g. fibromyalgia)
Major relevant allergies (e.g. food allergy, multiple allergies)
Recent (gastrointestinal) infection (within last 6 months)
Tattoo or body piercing placement within last 6 months
Known risk of Creutzfeldt Jacobs disease
History of current use of IV drugs
History of treatment with growth factors
Untreated infection with: Treponematoses, TBC, Herpes virus
Primary purpose
Allocation
Interventional model
Masking
30 participants in 2 patient groups, including a placebo group
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Central trial contact
Marc Benninga, prof.dr; Judith Zeevenhooven, PhD
Data sourced from clinicaltrials.gov
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