Gut Microbiota Clinical Trial
Official title:
Helicobacter Pylori Eradication Therapy in Portugal: Prospective, Randomized, Blind and Multicentre Trial on the Efficacy of Quadruple Therapies and Their Clinical Impact, and Immunological and Gut Microbiota Changes
NCT number | NCT05449028 |
Other study ID # | HpETIP |
Secondary ID | |
Status | Recruiting |
Phase | N/A |
First received | |
Last updated | |
Start date | May 1, 2022 |
Est. completion date | December 31, 2024 |
Helicobacter pylori (H. pylori) infection remains a major public health problem, with an estimated prevalence of over 50% worldwide and 60-86% for Portugal. H. pylori is associated with significant morbidity and mortality from peptic ulcerative disease to gastric cancer, whose eradication therapy has proven to be effective in preventing these complications. Factors involved in the development of these conditions include H. pylori virulence, host genetic factors and gut microbiota. Given the increasing pattern of antibiotic resistance evidenced by this bacterium and the scarcity of available antibiotic therapy, both in Portugal and worldwide, there is not enough evidence on the best eradication strategy. Regarding the uncertainties about the potential negative impact of indiscriminate use of eradication therapy on gut microbiota, either by proton pump inhibitors or by antibiotics per se, there is an overriding need for evidence about the real impact of this therapy on oral or gut flora and possible clinical consequences in immunological, metabolic, nutritional and oncological terms. Objectives: Comparative evaluation of the efficacy of the different quadruple therapy regimens recommended for the H. pylori eradication. Comparative evaluation of the safety profile in terms of clinical, and immunological and gut microbiota impact of the different therapies for the H. pylori eradication.
Status | Recruiting |
Enrollment | 230 |
Est. completion date | December 31, 2024 |
Est. primary completion date | December 31, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Gastric infection by H. pylori by histological examination of gastric biopsies or carbon 13-labeled urea breath test. Exclusion Criteria: - Age < 18 years; - Pregnant, breast-feeding or women of childbearing age who do not comply with effective anticonception measures; - History of allergy, hypersensitivity or contraindication to the use of H. pylori eradication drugs (antibiotics or proton pump inhibitors); - History of previous gastrointestinal surgery or neoplasia; - Previous H. pylori eradication therapies; Antibiotic or probiotic therapies in the month prior to recruitment; - Use of proton pump inhibitors, other antacids or gastric mucosal protection agents in the 2 weeks prior to recruitment; - Corticosteroids or immunomodulatory therapy in the month prior to recruitment; - Immunodeficiency; - Insulin-treated diabetes mellitus; - Obesity (Body mass index =30Kg/m2); - Use of laxative therapy in the 15 days prior to recruitment; - Decompensated heart, liver, kidney or respiratory diseases and; - Refusal or inability to give informed consent. |
Country | Name | City | State |
---|---|---|---|
Portugal | Centro Hospitalar e Universitário de Coimbra | Coimbra |
Lead Sponsor | Collaborator |
---|---|
Centro Hospitalar e Universitário de Coimbra, E.P.E. | University of Coimbra |
Portugal,
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* Note: There are 28 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Post-eradication changes assessed by immunological cells populations in immunological profile | Fresh peripheral blood samples will be collected and analyzed on 2 occasions: 1) baseline and 2) 12 months after treatment. A standard protocol with the conditions of collection, storage and transport of the different collected samples will be used. Analysis of immunological changes: Immunological profile will be analysed through the study of cell populations (CD4+, CD8+, B-cell, T-cell, natural killer cells, cells ratio) by multiparametric flow cytometry, before and 12 months after the H. pylori eradication therapy, by an independent operator who does not know the therapeutic scheme used. | Changes from baseline at 12 months after the intervention | |
Other | Post-eradication changes assessed by cytokines, chemokines and growth factors in immunological profile | Fresh peripheral blood samples will be collected and analyzed on 2 occasions: 1) baseline and 2) 12 months after treatment. A standard protocol with the conditions of collection, storage and transport of the different collected samples will be used. Analysis of immunological changes: Immunological profile will be analysed through the study of cytokines, chemokines and growth factors by xMAP/Luminex, before and 12 months after the H. pylori eradication therapy, by an independent operator who does not know the therapeutic scheme used. | Changes from baseline at 12 months after the intervention | |
Primary | Efficacy assessed by the eradication rate of the different therapeutic regimens recommended as H. pylori eradication therapy | Efficacy rate of H. pylori eradication will be determined for five different therapeutic regimens (sequential, hybrid and concomitants with or without bismuth). A successful eradication implies no documentation of H. pylori by carbon 13-labeled urea breath test or upper gastrointestinal endoscopy with biopsies, depending on clinical indication, at 1 month after H. pylori eradication (D40 or D44). A therapeutic regimen will be considered effective if it achieves more than 90% of H. pylori eradication (the minimum efficacy rate). | 1 month after the intervention | |
Primary | Efficacy assessed by the re-infection rate after the different therapeutic regimens recommended as H. pylori eradication therapy | At 12 months after H. pylori eradication, a carbon 13-labeled urea breath test will be performed to exclude re-infection. | 12 months after the intervention | |
Primary | Safety assessed by overall treatment-adverse events and and severe treatment-adverse events rates of the different therapeutic regimens recommended as H. pylori eradication therapy | Safety profile of H. pylori eradication will be determined for five different therapeutic regimens measuring adverse effects according to Medical Dictionary for Regulatory Activities (MedDRa). Therapy-related adverse events and its severity (by visual analogue scale of intolerance [0-10] and classification of the severity of adverse effects for the daily life activities according to [BoThBo96]) will be recorded at 1 month post-eradication follow-up. | 1 month after the intervention | |
Primary | Safety assessed by overall treatment completion rate of the different therapeutic regimens recommended as H. pylori eradication therapy | Safety profile of H. pylori eradication will be determined for five different therapeutic regimens measuring the treatment completion rate to the treatment at 1 month post-eradication follow-up. | 1 month after the intervention | |
Secondary | Post-eradication changes assessed by OTU and their relative abundance in gut microbiota | Stool samples shall be collected, stored at -20°C and then analyzed on 3 occasions: 1) baseline, 2) after stopping treatment (D10 or 14) and 3) 1 month after treatment (D40 or 44). A standard protocol with the conditions of collection, storage and transport of the different collected samples will be used. Analysis of gut microbiota by DNA sequencing using the hypervariable region of the 16S ribosomal bacteria gene as a taxonomic identification marker by bioinformatic analysis, for taxonomic identification and determination of the relative abundance of each Operational Taxonomy Units (OTU). The gut microbiota will be evaluated by an independent operator who does not know the therapeutic scheme used. | Changes from baseline at immediately after the intervention | |
Secondary | Post-eradication changes assessed by OTU and their relative abundance in gut microbiota | Stool samples shall be collected, stored at -20°C and then analyzed on 3 occasions: 1) baseline, 2) after stopping treatment (D10 or 14) and 3) 1 month after treatment (D40 or 44). A standard protocol with the conditions of collection, storage and transport of the different collected samples will be used. Analysis of gut microbiota by DNA sequencing using the hypervariable region of the 16S ribosomal bacteria gene as a taxonomic identification marker by bioinformatic analysis, for taxonomic identification and determination of the relative abundance of each Operational Taxonomy Units (OTU). The gut microbiota will be evaluated by an independent operator who does not know the therapeutic scheme used. | Changes from baseline at 1 month after the intervention |
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