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Sucrase-isomaltase Deficiency as a Cause of Irritable Bowel Syndrome

Primary Purpose

Irritable Bowel Syndrome, Sucrose Intolerance Due to Sucrase-Isomaltase Deficiency, Carbohydrate; Malabsorption

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Low-FODMAP diet
Starch- and Sucrose Reduced Diet (SSRD)
Sponsored by
Lovisenberg Diakonale Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Irritable Bowel Syndrome

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Validation of the 13C-labelled breath test to diagnose sucrase-isomaltase deficiency (n=40)

Inclusion Criteria:

  • Signed informed consent
  • BMI 18-30 kg/m2
  • Referred for gastroscopic examination with suspected GI disorder

Exclusion Criteria:

• Unwilling or not capable of signing the informed consent

Sucrase-isomaltase deficiency as a cause of symptoms in patients with irritable bowel syndrome (n=80)

Inclusion Criteria:

  • Signed informed consent
  • BMI 18-30 kg/m2
  • IBS diagnosis according to Rome IV criteria

Exclusion Criteria:

  • Inflammatory bowel disease, celiac disease or diabetes mellitus
  • Chronic immune diseases affecting the GI-system
  • Unwilling/unable to maintain a stable diet throughout the study period
  • Use of antibiotic treatment for the last 4 weeks
  • Currently on a restrictive diet

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Experimental

    Arm Label

    Low-FODMAP diet

    Starch- and Sucrose Reduced Diet

    Arm Description

    Patients with IBS on a 4-week low-FODMAP diet.

    Patients with IBS on a s 4-week Starch- and Sucrose Reduced Diet (SSRD).

    Outcomes

    Primary Outcome Measures

    IBS symptom severity
    Symptom severity measured by the IBS-Symptom Severity Scale (IBS-SSS)

    Secondary Outcome Measures

    Gut microbiota composition
    Analysis of fecal samples for evaluation of microbiota composition in fecal samples collected at baseline and after each 4-week diet intervention
    Fecal fermentation measured by short chain fatty acids (SCFAs)
    Analysis of SCFAs in fecal samples collected at baseline and after each 4-week diet intervention
    Quality of life in IBS
    Assessment of quality of life by the Patient Reported Outcome Measurement Information System (PROMIS-29)

    Full Information

    First Posted
    December 6, 2021
    Last Updated
    January 18, 2022
    Sponsor
    Lovisenberg Diakonale Hospital
    Collaborators
    University of Bergen
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05159115
    Brief Title
    Sucrase-isomaltase Deficiency as a Cause of Irritable Bowel Syndrome
    Official Title
    Sucrase-isomaltase Deficiency as a Cause of Irritable Bowel Syndrome
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    November 2021
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    March 14, 2022 (Anticipated)
    Primary Completion Date
    June 30, 2026 (Anticipated)
    Study Completion Date
    December 31, 2027 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Lovisenberg Diakonale Hospital
    Collaborators
    University of Bergen

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    Irritable bowel syndrome (IBS) is a functional disorder causing troublesome symptoms and reduced quality of life. It affects 10-20% of the population, hence creates large costs for society. About 30-40% of all IBS patients do not benefit from current treatment options. Sucrase-isomaltase (SI) deficiency is an unexplored condition, that may explain symptoms in IBS patients who experience no effect from today's treatments. Currently, a duodenal biopsy is the gold standard for the diagnosis of SI deficiency, however the condition is not well investigated. A 13C-labelled breath test holds promise as a non-invasive alternative, but it has not previously been validated. This project will address the knowledge gap related to a possible association between SI deficiency and IBS by addressing two research questions that have never been answered before. We aim to: Validate the 13C-labelled breath test as a diagnostic tool by assessing the strength of the association between the breath test and SI activity measured in duodenal biopsies Use the 13C-labelled breath test in a randomized dietary crossover trial comparing a starch and sucrose reduced diet (SSRD) with the standard low-FODMAP diet in IBS patients, to evaluate whether SI activity is associated with dietary changes according to symptom severity and gut microbiota composition
    Detailed Description
    The projects includes two studies: Study 1: Validation of the 13C-labelled breath test to diagnose sucrase-isomaltase deficiency Background: In order to validate the 13C-sucrose breath test to diagnose SI deficiency, the test result must be compared to the "gold standard" method for diagnosis; i.e. measurements of enzyme activity from intestinal biopsies by "The Dahlquist Method", and a reference material must be established. Objective: To compare results from the 13C-labelled breath test to enzyme activity measured in biopsies collected from the proximal small intestine in a limited patient group referred for a gastroscopic examination. Design: A cross-sectional study. Primary endpoint: SI activity as measured with a breath test and enzyme activity with assay of biopsy material. Recruitment and patient characteristics: Patients referred for gastroscopic examination with duodenal biopsies and with suspected GI disorder, will be included consecutively. Sample size: We aim to include 40 patients. No studies validating breath test results in our patient group are available. However, based on preliminary results suggesting that 35% of IBS patients have SI deficiency,13 we are 95% likely to find between 8 and 21 patients with SI deficiency when examining 40 patients. Assuming 80% concordance between the two methods to (correct proportion of successes), we would need 12 positive cases. Thus, if 40 individuals are included, the study is sufficiently powered (alpha=5% and beta=20%, using McNemar's test of concordance). Study 2: Sucrase-isomaltase deficiency as a cause of symptoms in patients with irritable bowel syndrome Objectives: To examine the effect of a 4-week SSRD on GI- and extraintestinal symptoms, gut microbiota composition and fecal fermentation in patients with IBS (with and without SI deficiency), and compare the SSRD with a 4-week low-FODMAP diet to investigate whether the patients with a breath test result indicating SI deficiency respond better to the SSRD than the patients with normal SI activity. Gut microbiota have been suggested to have a central role in IBS etiology, hence evaluation of gut microbiota composition and fecal fermentation will be included to increase the knowledge regarding the effects of dietary change on gut microbiota composition and activity related to SI deficiency. Design: A randomized, open clinical crossover trial with a dietary intervention in a group of IBS patients, lasting for 4+4 weeks (SSRD vs. low-FODMAP) with a 1-week wash-out period in between. Breath tests will be taken at inclusion, but the results will be "blinded", e.g. not available for anyone conducting the trial before end of the study. A SSRD will be compared to the low-FODMAP diet. All participants will be given dietary advice from a registered clinical dietitian. Briefly, all forms of sucrose-containing foods (e.g. sweets, jam, and cakes) should be avoided, and foods rich in starch should be reduced on the SSRD. Primary endpoint: Symptom severity by IBS-Symptom Severity Scale (IBS-SSS). Secondary endpoints: Gut microbiota composition, fecal fermentation measured by short chain fatty acids (SCFAs) and assessment of quality of life by the Patient Reported Outcome Measurement Information System (PROMIS-29). Recruitment and patient characteristics: IBS patients referred to the outpatient clinic at the Department of Gastroenterology at Lovisenberg Diaconal Hospital for dietary guidance by a registered dietitian will be consecutively included. Sample size: The primary end point is change in IBS symptom severity (IBS-SSS) at the end of the treatment period relative to baseline, and the proportion of responders to the dietary intervention is based on the recommended cut-off of a reduction (ie, improvement) in total IBS-SSS score of 50 points, which is considered to be clinically meaningful improvement. To plan our sample size, we performed a power calculation based on the ability to detect a difference between the two diets in reduction of IBS-SSS score of at least 50 points with 80% power, assuming an SD of 100. The calculation indicated that we would need 64 patients. To allow for 15-20% drop-out, we aim to include 80 patients.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Irritable Bowel Syndrome, Sucrose Intolerance Due to Sucrase-Isomaltase Deficiency, Carbohydrate; Malabsorption, Sucrase Isomaltase Deficiency, Functional Gastrointestinal Disorders

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Crossover Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    80 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Low-FODMAP diet
    Arm Type
    Active Comparator
    Arm Description
    Patients with IBS on a 4-week low-FODMAP diet.
    Arm Title
    Starch- and Sucrose Reduced Diet
    Arm Type
    Experimental
    Arm Description
    Patients with IBS on a s 4-week Starch- and Sucrose Reduced Diet (SSRD).
    Intervention Type
    Other
    Intervention Name(s)
    Low-FODMAP diet
    Intervention Description
    4 weeks of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs)
    Intervention Type
    Other
    Intervention Name(s)
    Starch- and Sucrose Reduced Diet (SSRD)
    Intervention Description
    4 weeks of a diet low in starch and sucrose
    Primary Outcome Measure Information:
    Title
    IBS symptom severity
    Description
    Symptom severity measured by the IBS-Symptom Severity Scale (IBS-SSS)
    Time Frame
    4 weeks
    Secondary Outcome Measure Information:
    Title
    Gut microbiota composition
    Description
    Analysis of fecal samples for evaluation of microbiota composition in fecal samples collected at baseline and after each 4-week diet intervention
    Time Frame
    4 weeks
    Title
    Fecal fermentation measured by short chain fatty acids (SCFAs)
    Description
    Analysis of SCFAs in fecal samples collected at baseline and after each 4-week diet intervention
    Time Frame
    4 weeks
    Title
    Quality of life in IBS
    Description
    Assessment of quality of life by the Patient Reported Outcome Measurement Information System (PROMIS-29)
    Time Frame
    4 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    90 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Validation of the 13C-labelled breath test to diagnose sucrase-isomaltase deficiency (n=40) Inclusion Criteria: Signed informed consent BMI 18-30 kg/m2 Referred for gastroscopic examination with suspected GI disorder Exclusion Criteria: • Unwilling or not capable of signing the informed consent Sucrase-isomaltase deficiency as a cause of symptoms in patients with irritable bowel syndrome (n=80) Inclusion Criteria: Signed informed consent BMI 18-30 kg/m2 IBS diagnosis according to Rome IV criteria Exclusion Criteria: Inflammatory bowel disease, celiac disease or diabetes mellitus Chronic immune diseases affecting the GI-system Unwilling/unable to maintain a stable diet throughout the study period Use of antibiotic treatment for the last 4 weeks Currently on a restrictive diet
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Jørgen Valeur, PhD
    Phone
    0047 23225140
    Email
    jorgen.valeur@lds.no

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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