Evaluation of Fecal Microbiome Changes After Antegrade Continence Enema Placement and Initiation of Bowel Flush Regimen
Overview
- Phase
- Phase 4
- Intervention
- PEG 3350
- Conditions
- Constipation
- Sponsor
- Indiana University
- Enrollment
- 50
- Locations
- 2
- Primary Endpoint
- Change in Fecal Microbiome at 4 months
- Status
- Recruiting
- Last Updated
- 10 months ago
Overview
Brief Summary
This study will evaluate changes in the fecal microbiome in constipated pediatric patients before and after antegrade continence enema placement and initiation of antegrade enema flushes. Subjects will have their microbiome sequenced prior to placement by obtaining a fecal sample. Pre-antegrade continence enema placement results will be compared to fecal samples obtained at 0, 4, 8 months after placement of the antegrade continence enema and initiation of miralax or golytely flushes to look for changes in bacterial diversity.
Detailed Description
This is a prospective, longitudinal study of children 2 -18 years of age who undergo a clinical Malone Antegrade Continence Enema (MACE) appendicostomy or cecostomy for treatment of chronic functional constipation as defined by the Rome IV criteria. Only patients with intact motility on colonic manometry (CMS) will be included. The antegrade enema flush medication regimen will be randomized in 1:1 ratio of PEG 3350 and PEG3350 with electrolytes. The study statistician will create a blocked randomization schedule which will be uploaded into REDCap. Glycerin and stimulant laxatives will be titrated as needed by a pediatric gastroenterologist in conjunction with the pediatric general surgery team. Neither patient nor providers will be blinded to laxative randomization as objective data in the form of microbiome composition is being evaluated. Patients will have a pre-MACE placement stool sample obtained at time of colonic motility studies and repeat stool samples collected at 1 month, 4 months and 8 months post-MACE placement and initiation of antegrade enemas. Post-MACE samples will be submitted at standard follow-up appointments. All stool samples will be self-collected by patients. Samples will be collected with the OMNIgene GUT kit which provides stabilization of DNA at room temperature for up to 60 days. Once the sample is collected by the research team, sample tubes will be stored at -80 Celsius until all samples are collected and sent for sequencing. Pre-MACE stool samples will be collected while abstaining from osmotic laxative therapy for one week. If patients do not spontaneously pass stool during the week of osmotic laxative abstention, stool will be collected from the first bowel movement after pre-CMS bowel flush with PEG 3350 with or without electrolytes has been initiated. Data regarding if stool collection occurred before or after receiving PEG 3350 with or without electrolytes for CMS bowel flush will be recorded. Patients will perform daily flushes after MACE placement and post-MACE stool samples will be collected within the first 10 minutes of flush initiation.
Investigators
Kathryn Hawa, DO
Principle Investigator
Indiana University
Eligibility Criteria
Inclusion Criteria
- •Recalcitrant chronic functional constipation necessitating a MACE appendicostomy or cecostomy for treatment at Riley Hospital for Children
- •Intact colonic motility as evidenced by CMS studies
- •Exclusion Criteria
- •Underlying anatomic or pathologic etiology for constipation
- •History of prior gastrointestinal surgery (excluding placement of G or GJ tubes)
- •Underlying severe GI disease unrelated to the patient's chronic constipation
- •Use within the past month of consent of probiotic supplements, prebiotic supplements or antibiotics
Exclusion Criteria
- Not provided
Arms & Interventions
PEG 3350
Patients will receive PEG 3350 (miralax or generic equivalent) for their MACE flushes.
Intervention: PEG 3350
PEG 3350
Patients will receive PEG 3350 (miralax or generic equivalent) for their MACE flushes.
Intervention: Glycerin
PEG 3350 with electrolytes
Patients will receive PEG 3350 with electrolytes (Go-Lytely or generic equivalent) for their MACE flushes.
Intervention: PEG-3350 with electrolytes
PEG 3350 with electrolytes
Patients will receive PEG 3350 with electrolytes (Go-Lytely or generic equivalent) for their MACE flushes.
Intervention: Glycerin
Outcomes
Primary Outcomes
Change in Fecal Microbiome at 4 months
Time Frame: At baseline and 4 months post-MACE
The purpose of this study is to determine if a sustained change in the fecal microbiome occurs after prolonged use of an antegrade continence enema bowel flush regimen. Patients' microbiomes will be evaluated via 16s rRNA sequencing
Change in Fecal Microbiome at 8 months
Time Frame: At baseline and 8 months post-MACE
The purpose of this study is to determine if a sustained change in the fecal microbiome occurs after prolonged use of an antegrade continence enema bowel flush regimen. Patients' microbiomes will be evaluated via 16s rRNA sequencing
Change in Fecal Microbiome at 1 month
Time Frame: At baseline and 1 month post-MACE
The purpose of this study is to determine if a sustained change in the fecal microbiome occurs after prolonged use of an antegrade continence enema bowel flush regimen. Patients' microbiomes will be evaluated via 16s rRNA sequencing
Secondary Outcomes
- Effect of Bowel Regimen Solution on Fecal Bacterial Diversity(Through study completion, approximately 8 months)
- Effect of Glycerin on Fecal Microbiome Diversity(Through study completion, approximately 8 months)
- Effect of Redundant Sigmoid Colon on Microbiome Diversity(Through study completion, approximately 8 months)