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Therapeutic Effect of Ursodeoxycholic Acid in Functional Dyspepsia

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ClinicalTrials.gov Identifier: NCT03004118
Recruitment Status : Unknown
Verified November 2016 by Universitaire Ziekenhuizen Leuven.
Recruitment status was:  Not yet recruiting
First Posted : December 28, 2016
Last Update Posted : December 28, 2016
Sponsor:
Information provided by (Responsible Party):
Universitaire Ziekenhuizen Leuven

Brief Summary:

The investigators aim to evaluate ursochol as a therapy in functional dyspepsia. The objectives of the study are to evaluate the effect of ursochol on duodenal permeability and dyspeptic symptoms and on duodenal low-grade inflammation, bile acid composition, bile acid receptor expression, nutrient tolerance and intragastric pressure.

Cross-over, controlled, randomized, double blinded, placebo-controlled trial with a 4 week intake of ursodeoxycholic acid (ursochol) versus a 4 week intake of placebo and a 4 week washout period in between. Two study days are planned during week 4 and week 12. During the 14 weeks, the patients have to fill in a diary. And for 14 weeks in total, the patients have to discontinue intake of proton pump inhibitors, drugs effecting gastric motility and NSAIDs and replace their oral anticonception with non-oral anticonception. Every two weeks of the study the investigator will call the participants to see how they are/if they have any discomforts or side effects.


Condition or disease Intervention/treatment Phase
Functional Dyspepsia Dietary Supplement: Nutridrink Device: High resolution manometry probe Device: perfusion catheter Drug: Placebo Oral Tablet Drug: Ursochol oral tablet Device: Duodenal fluid aspiration catheter Procedure: Duodenogastroscopy Procedure: Blood sample Phase 4

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Detailed Description:

Functional dyspepsia patients will be recruited and screened for inclusion in the study. The participants will be asked to not take proton pump inhibitors, drugs effecting gastric motility and NSAIDs and oral anticonception for fourteen weeks. First, they will stop with their daily drug intake of PPIs and NSAIDs for two weeks, then they will take placebo or UDC for four weeks, two doses every day during lunch and dinner. Afterwards, there will be a washout period of four weeks, and again four weeks of UDC or placebo intake. The patients will receive a diary in which they describe their symptoms/discomforts every day for 14 weeks. All participants and the investigator will be blinded to the nature (UDC or placebo) of the pills. The random order in which a certain patient gets his pills has been decided by the pharmacy of UZ Leuven and is also unknown for the investigator (double blinded). During week two, four, six, eight, ten and twelve we will have a phone conversation with the patients to discuss their symptoms/discomforts.

During week four and week twelve, the patients will come to the hospital for one day after an overnight fast. First, they are asked to fill in a bundle of questionnaires concerning physical complaints, depression, anxiety (disturbances), pain/disease, body/interoceptive awareness, trauma/abuse and personality and to give a fecal sample that they've collected the day before. The fecal sample will be used to evaluate the gastrointestinal microbiota in FD patients. Then, two blood samples, to evaluate liver function parameters and bile acid synthesis, will be taken and an endoscopy will be performed. All endoscopies will be performed by an experienced endoscopist (Jan Tack) and nine duodenal biopsies (2 biopsies at a time) (Radial Jaw™3 with needle; outside diameter 2.2mm; Boston Scientific, 302 Parkway, Global Park, Heredia, Costa Rica) will be obtained. To measure the in vitro transepithelial resistance, 3 biopsies will be examined using an adapted mini-Ussing chambers system. After equilibration, the mucosal side of the tissue will be exposed to 4kDa FITC-dextran as a measure of paracellular permeability. A sample will be taken from the serosal side during 2h at 30min interval. The concentration of fluoresceïn will then be measured using a fluorescence plate reader. Also, two biopsies will be used for mRNA extraction and subsequent cDNA synthesis. This cDNA will be used to measure the gene expression of bile acid receptors by means of real-time RT-PCR. In addition, one biopsy will be prepared for immunohistochemistry and two will be used for western blot to measure changes in distribution/expression of the bile acid receptor proteins. One biopsy will be obtained to study ultrastructural alterations by transmission electron microscopy.

After the endoscopy, an aspiration catheter will be positioned in the duodenum. The position of the catheter will be briefly checked by fluoroscopy (typically 2-3 seconds, however never more than 15 seconds). After positioning of the catheter, it is fixed to the subject's chin and he/she is asked to take place in a chair for the remainder of the experiment. For one hour, every 15 minutes duodenal fluids will be collected during fasted state. Next, a high resolution manometry catheter (HRM) will be placed in the gastric fundus to measure intragastric pressure and a perfusion tube (OD 2 mm) will be introduced through the nose and positioned in the stomach. After positioning of the catheters, they are fixed to the subject's chin and he/she is asked to take place in a chair for the remainder of the experiment. After a stabilization period of 15 minutes, intragastric infusion of the nutrient drink (Nutridrink, Nutricia; 630 KJ, 6 g proteins, 18.4 g carbohydrates, and 5.8 g lipids per 100 mL) will start at a constant speed of 60 mL per minute (determined by an automated system using a peristaltic pump). Intragastric pressure will be measured with a 36-channel high resolution manometry system, through the intragastric manometry probe. At 1-minute intervals, the subjects will be asked to score their satiation using a graphic rating scale that combines verbal descriptors on a scale graded 0-5. At 5-minute intervals the volunteers will be asked to fill out a VAS for 11 dyspeptic symptoms. The intragastric infusion will be stopped as soon as the volunteers score maximally on one of the 11 epigastric symptoms or when a score of 5 is reached on their satiety scores. 10 minutes thereafter, the catheters will be disconnected and removed. After the nutrient drink infusion, duodenal fluids will be collected every 15 minutes for 1.5 hour during fed state. Finally, the last catheter is removed and the volunteer can go home.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 16 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Therapeutic Effect of Ursodeoxycholic Acid on Duodenal Permeability and Meal Related Sensory Motor Function in Functional Dyspepsia Patients
Study Start Date : January 2017
Estimated Primary Completion Date : November 2017
Estimated Study Completion Date : November 2017

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Indigestion
Drug Information available for: Ursodiol

Arm Intervention/treatment
Active Comparator: Ursochol
About 10.5mg/kg/day of ursochol (calculated before start study for each participant individually) (combination of ursochol 150 and 300) divided in 2 doses per day (during lunch and dinner). Oral intake. Tablets. 4 weeks.
Dietary Supplement: Nutridrink
Liquid meal of 200ml

Device: High resolution manometry probe
Catheter inserted via the nose into the stomach to measure intragastric pressure.

Device: perfusion catheter
Catheter inserted via the nose into the stomach to perfuse the nutridrink intragastricly.

Drug: Ursochol oral tablet
4 week oral intake (daily) (dose of 10.5mg/kg/day)

Device: Duodenal fluid aspiration catheter
Catheter inserted via the nose into the duodenum to aspirate duodenal fluids for 2.5 hours.

Procedure: Duodenogastroscopy
Catheter inserted via the mounth into the duodenum to take duodenal biopsies.

Procedure: Blood sample
Blood sample will be taken to measure liver enzyme serum levels and marker for bile acid synthesis.

Placebo Comparator: Placebo
Same amount of pills as ursochol (calculated before start study for each participant individually) divided in 2 doses per day (during lunch and dinner). Oral intake. Tablets. 4 weeks.
Dietary Supplement: Nutridrink
Liquid meal of 200ml

Device: High resolution manometry probe
Catheter inserted via the nose into the stomach to measure intragastric pressure.

Device: perfusion catheter
Catheter inserted via the nose into the stomach to perfuse the nutridrink intragastricly.

Drug: Placebo Oral Tablet
4 week oral intake (daily)

Device: Duodenal fluid aspiration catheter
Catheter inserted via the nose into the duodenum to aspirate duodenal fluids for 2.5 hours.

Procedure: Duodenogastroscopy
Catheter inserted via the mounth into the duodenum to take duodenal biopsies.

Procedure: Blood sample
Blood sample will be taken to measure liver enzyme serum levels and marker for bile acid synthesis.




Primary Outcome Measures :
  1. Duodenal mucosal transepithelial electrical resistance (TEER) (Ohm*cm^2) measured with adapted ussing chamber system [ Time Frame: 2 hours ]
    Transepithelial resistance is a measure for mucosal integrity

  2. Duodenal mucosal paracellular passage of Fitc Dextran 4kDa (pmol) measured with FLUOstar Omega microplate reader. [ Time Frame: 2 hours ]
    Paracellular permeability is a measure for mucosal integrity

  3. Dyspeptic symptom occurence and intensity during meal intake via questionnaire every 1 minute until end of the meal [ Time Frame: About 10 minutes ]
    Scoring of dyspeptic symptom occurence by patients during nutrientdrink perfusion

  4. Daily occurence and intensity of dyspeptic symptoms via LPDS diary [ Time Frame: 14 weeks ]
    Leuven Postprandial Distress Scale, a questionnaire for symptom assessment in the functional dyspepsia/postprandial distress syndrome.


Secondary Outcome Measures :
  1. Glycocholic acid concentration (mM) [ Time Frame: 14 weeks ]
    Bile salt

  2. Taurocholic acid concentration (mM) [ Time Frame: 14 weeks ]
    Bile salt

  3. Glycochenodeoxycholic acid concentration (mM) [ Time Frame: 14 weeks ]
    Bile salt

  4. Taurochenodeoxycholic acid concentration (mM) [ Time Frame: 14 weeks ]
    Bile salt

  5. Glycodeoxycholic acid concentration (mM) [ Time Frame: 14 weeks ]
    Bile salt

  6. Taurodeoxycholic acid concentration (mM) [ Time Frame: 14 weeks ]
    Bile salt

  7. Glycoursodeoxycholic acid concentration (mM) [ Time Frame: 14 weeks ]
    Bile salt

  8. Tauroursodeoxycholic acid concentration (mM) [ Time Frame: 14 weeks ]
    Bile salt

  9. Protein expression of duodenal bile acid receptor VDR [ Time Frame: 14 weeks ]
    Western blot

  10. Protein expression of duodenal bile acid receptor FXR [ Time Frame: 14 weeks ]
    Western blot

  11. Protein expression of duodenal bile acid receptor PXR [ Time Frame: 14 weeks ]
    Western blot

  12. Protein expression of duodenal bile acid receptor TGR5 [ Time Frame: 14 weeks ]
    Western blot

  13. Protein expression of duodenal bile acid receptor CAR [ Time Frame: 14 weeks ]
    Western blot

  14. RNA expression of duodenal bile acid receptor VDR [ Time Frame: 14 weeks ]
    Real time RT-PCR

  15. RNA expression of duodenal bile acid receptor FXR [ Time Frame: 14 weeks ]
    Real time RT-PCR

  16. RNA expression of duodenal bile acid receptor PXR [ Time Frame: 14 weeks ]
    Real time RT-PCR

  17. RNA expression of duodenal bile acid receptor TGR5 [ Time Frame: 14 weeks ]
    Real time RT-PCR

  18. RNA expression of duodenal bile acid receptor CAR [ Time Frame: 14 weeks ]
    Real time RT-PCR

  19. Intragastric pressure measurement via an high resolution manometry (HRM) probe [ Time Frame: 1 hour ]
  20. Mast cell count in duodenal biopsies (number of mastcells/ mm^2 lamina propria) [ Time Frame: 14 weeks ]
  21. Eosinophil count in duodenal biopsies (number of eosinophils/ mm^2 lamina propria) [ Time Frame: 14 weeks ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Men and women (age 18-60 years) who meet the Rome IV criteria for functional dyspepsia can participate in the study. For 14 weeks, patients need to discontinue their intake of proton pump inhibitors, drugs effecting gastric motility and NSAIDs. If a female participant takes oral anticonception, she has to switch to non-oral anticonception for this study. All participants will receive and sign a copy of the informed consent.

Exclusion Criteria:

  • refused informed consent
  • pregnant women or women who are breastfeeding
  • diabetes mellitus
  • celiac disease
  • coagulation disorders/anticoagulant therapy
  • not well functioning liver and gallbladder
  • active stomach or gut ulcer
  • biliary colic, calcified gallstones
  • acute infection of gallbladder or bile ducts, bile duct obstruction
  • intestinal disorders such as ulcerative colitis, Crohn's disease
  • lactose intolerance
  • allergies/sensitivity (asthma, allergic to bile acids, eczema, allergic rhinoconjunctivitis)
  • Intake of oral anticonception, barbiturates, antacid, colestyramine or colestipol, nitrendipine, cyclosporine, ciprofloxacine, rosuvastatine.
  • first degree relatives with celiac disease, Crohn's disease or type I diabetes mellitus Severe kidney malfunction

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03004118


Contacts
Contact: Jan Tack, prof dr +3216 37 74 74 jan.tack@med.kuleuven.be

Sponsors and Collaborators
Universitaire Ziekenhuizen Leuven

Responsible Party: Universitaire Ziekenhuizen Leuven
ClinicalTrials.gov Identifier: NCT03004118     History of Changes
Other Study ID Numbers: UDC1
First Posted: December 28, 2016    Key Record Dates
Last Update Posted: December 28, 2016
Last Verified: November 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Additional relevant MeSH terms:
Ursodeoxycholic Acid
Dyspepsia
Gastritis
Signs and Symptoms, Digestive
Signs and Symptoms
Gastroenteritis
Gastrointestinal Diseases
Digestive System Diseases
Stomach Diseases
Cholagogues and Choleretics
Gastrointestinal Agents