Gastro-intestinal Physiology After Anti-Reflux Procedures (GASP)
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ClinicalTrials.gov Identifier: NCT05238636 |
Recruitment Status :
Recruiting
First Posted : February 14, 2022
Last Update Posted : November 28, 2022
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Gastro-oesophageal reflux disease (GORD) affects 1 in 4 adults and is a condition where stomach acid leaks back up into the oesophagus (gullet). It can cause an uncomfortable burning feeling in the chest and even lead to problems such as cancer of the oesophagus. Thankfully most people feel better by changing their diet or taking medications, but for others it can be severe, and they may need to consider having surgery to tighten the internal muscles and stop acid leaking back up. The most common operation is the "laparoscopic fundoplication", which is a keyhole procedure where the top of the stomach is wrapped around the lower oesophagus. Alternatively, the "LINX device" is a keyhole procedure where a magnetic bracelet is placed around the lower oesophagus. The "Stretta procedure" is a non-surgical option, where a probe is placed in the mouth to the oesophagus, where heat energy is applied to strengthen the muscles. All three procedures have been shown to be effective at helping people feel better, but less is known about how exactly they do this and there are not many studies that have been done to compare these procedures.
This study will perform tests on adult patients at St George's University Hospitals NHS Foundation Trust before and again 6 months after their surgery (laparoscopic fundoplication, LINX device or Stretta procedure). The tests are safe and are mostly performed in routine care.
The tests will analyse how surgery affects:
- the strength of the oesophagus muscles
- the amount of acid leaking up
- how sensitive the oesophagus is to acid
- symptoms
This should help lead to a better understanding of what changes are important to make people feel better from GORD and help inform treatment decisions with patients in future.
Condition or disease | Intervention/treatment |
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Gastroesophageal Reflux | Procedure: Anti-reflux surgery - Stretta procedure or LINX device or laparoscopic fundoplication |
Study Type : | Observational |
Estimated Enrollment : | 60 participants |
Observational Model: | Cohort |
Time Perspective: | Prospective |
Official Title: | The Effect of Anti-reflux Procedures (Stretta, LINX, and Fundoplication) on Physiological Parameters Contributing to Symptom Resolution in Adults With Gastro-oesophageal Reflux at a Single UK Tertiary Centre |
Actual Study Start Date : | May 12, 2022 |
Estimated Primary Completion Date : | January 10, 2024 |
Estimated Study Completion Date : | January 20, 2024 |
Group/Cohort | Intervention/treatment |
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Stretta
Patients that have undergone or are to undergo the Stretta procedure
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Procedure: Anti-reflux surgery - Stretta procedure or LINX device or laparoscopic fundoplication
This is an observational study. Patients will choose which anti-reflux procedure (Stretta, LINX or fundoplication) they undergo with their clinician, as is standard practice, after which they will be offered recruitment to this study, which will perform investigations to assess for changes in physiology and symptoms. |
LINX
Patients that have undergone or are to undergo the LINX device
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Procedure: Anti-reflux surgery - Stretta procedure or LINX device or laparoscopic fundoplication
This is an observational study. Patients will choose which anti-reflux procedure (Stretta, LINX or fundoplication) they undergo with their clinician, as is standard practice, after which they will be offered recruitment to this study, which will perform investigations to assess for changes in physiology and symptoms. |
Laparoscopic fundoplication
Patients that have undergone or are to undergo laparoscopic fundoplication.
|
Procedure: Anti-reflux surgery - Stretta procedure or LINX device or laparoscopic fundoplication
This is an observational study. Patients will choose which anti-reflux procedure (Stretta, LINX or fundoplication) they undergo with their clinician, as is standard practice, after which they will be offered recruitment to this study, which will perform investigations to assess for changes in physiology and symptoms. |
- Lower oesophageal sphincter (LOS) pressure [ Time Frame: Before and again 6 months after anti-reflux surgery ]Measured in mm Hg with high resolution oesophageal manometry
- Gastro-oesophageal junction (GOJ) distensibility index [ Time Frame: Before and again 6 months after anti-reflux surgery ]EndoFLIP will be performed to calculate teh GOJ-distensibility index (DI) by dividing the median GOJ-midline cross-sectional area (CSA) by the median intra-balloon pressure over the duration of the 60mL distension, in mm2/mmHg.
- Oesophageal acid exposure [ Time Frame: Before and again 6 months after anti-reflux surgery ]24hour ambulatory pH monitoring and 96hour BRAVO capsule placement used to calculate % of time lower oesophageal pH is < 4 (normal is <6%)
- Oesophageal sensitivity to acid [ Time Frame: Before and again 6 months after anti-reflux surgery ]Measured with Bernstein test (0.1M hydrochloric acid oesophageal perfusion) as time (min) to reproduce symptoms of GORD
- Oesophageal biopsies [ Time Frame: Before and again 6 months after anti-reflux surgery ]Immunohistochemistry to measure the density of calcitonic related gene peptide (CRGP)
- Symptoms [ Time Frame: Before and again 6 months after anti-reflux surgery ]Hull Airway Reflux Questionnaire (HARQ), Reflux Symptom Index (RSI), Hospital Odynophagia and Dysphagia Questionnaire (HODQ), Reflux Disease Questionnaire (RDQ), Epworth Sleepiness Scale, and GERD-HRQL symptom questionnaires to grade symptoms
Biospecimen Retention: Samples Without DNA
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Ages Eligible for Study: | 18 Years to 90 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Sampling Method: | Non-Probability Sample |
Inclusion Criteria:
- Patient under the care of St George's University Hospital NHS Foundation Trust, London
- Decision to specifically undergo Stretta procedure, laparoscopic fundoplication or LINX device (N.B. this study will have no involvement in that decision or choice of procedure)
- Symptoms compatible with GORD, e.g. heartburn, regurgitation, chest pain
- Physiological evidence of GORD, e.g. endoscopy, HRM, pH studies
- Male or Female
- Age 18 to 90
Exclusion Criteria:
- Patients < 18 years old or >90 years old
- Patients with significant medical co-morbidities
- Patients unable to provide consent for study participation
- Patients unable to easily attend hospital for the physiological tests
- Patients who have had complications from their anti-reflux procedure
- Patients who have previously undergone oesophageal surgery
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): NCT05238636
Contact: Joseph Cooney | 02087254986 | joseph.cooney@nhs.net | |
Contact: Rosie Jacobs | 02087254986 | researchgovernance@sgul.ac.uk |
United Kingdom | |
St Georges University Hospitals NHS Foundation Trust | Recruiting |
London, United Kingdom, SW17 0RE | |
Contact: Joseph Cooney joseph.cooney@nhs.net | |
Contact: Rosie Jacobs 02087254986 researchgovernance@sgul.ac.uk |
Study Director: | Jamal Hayat | St George's University Hospitals NHS Foundation Trust | |
Principal Investigator: | Joseph Cooney | St George's University Hospitals NHS Foundation Trust |
Responsible Party: | St George's, University of London |
ClinicalTrials.gov Identifier: | NCT05238636 |
Other Study ID Numbers: |
2021.0212 296193 ( Other Identifier: IRAS ) |
First Posted: | February 14, 2022 Key Record Dates |
Last Update Posted: | November 28, 2022 |
Last Verified: | November 2022 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Stretta Laparoscopic fundoplication LINX |
Gastroesophageal Reflux Esophageal Motility Disorders Deglutition Disorders |
Esophageal Diseases Gastrointestinal Diseases Digestive System Diseases |