Diarrhea-Predominant Irritable Bowel Syndrome in Persian Gulf Veterans
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 54
- 试验地点
- 1
- 主要终点
- Global Improvement Scale
研究概览
简要总结
The purposes of this study are to estimate the burden of disease due to chronic gastrointestinal illness in PG veterans, to evaluate whether Small Bowel Bacterial Overgrowth (SBBO) is associated with chronic diarrhea in PG veterans, and to determine whether eradication of SBBO reduces symptoms of chronic diarrhea, abdominal pain and bloating in PG veterans.
详细描述
Approximately 700,000 United States military personnel were deployed in the first Persian Gulf (PG) War. Several months after their return, up to 25% of Veterans had persistent symptoms which they suspected were related to their military service in the Gulf. Among the most frequent were gastrointestinal symptoms such as loose stools, excessive gas and abdominal pain. These symptoms are typical of diarrhea-predominant irritable bowel syndrome (IBS).
The cause of IBS is not known; speculated mechanisms include altered GI motility, bacterial overgrowth, visceral hypersensitivity and psychological stress. Another proposed mechanism relates to the fact that up to one third of patients with IBS describe the onset of their symptoms following acute gastroenteritis. This is called post-infective IBS (PI-IBS). How acute gastroenteritis leads to persistent GI symptoms of IBS is not known. A limited amount of data suggests that patients with IBS may have an imbalance in their gastrointestinal microflora. Several studies indicate that small bowel bacterial overgrowth is more common in individuals with IBS. Symptoms of SBBO are similar to diarrhea-predominant IBS and include chronic diarrhea, bloating and abdominal pain.
More than 50 percent of military personnel developed acute gastroenteritis while on duty in the Gulf. Most of them who reported symptoms of IBS had an acute onset which occurred in association with an episode of acute gastroenteritis during their tour of duty. Other travelers are known to be colonized by new micro-organisms during travel to foreign countries. This acquisition is thought to be related to a change in diet. The natural history of this change in bowel flora, in part, depends on host factors and can persist for months after travel abroad. It seems likely, that PG veterans with persistent diarrhea and a negative work-up for known GI diseases have PI-IBS. No study in the past has evaluated the role of SBBO in causing chronic GI symptoms in PG Veterans. Furthermore, soldiers involved in combat are exposed to a highly stressful environment, perhaps making them more susceptible to persistent symptoms.
We hypothesize that PG veterans with chronic GI symptoms have symptoms of diarrhea predominant IBS and this is caused by SBBO due to a change in microflora during deployment in the Persian Gulf and that it is predisposed to by the stress of combat. Intestinal microflora, once altered, is known to be relatively stable; once mucosal damage occurs it may become permanent.
Objectives Objective # 1: Estimate the burden of disease due to chronic gastrointestinal illness in PG veterans.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 35 Years 至 72 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men and women age 32-75 years
- •Rome III criteria for diarrhea-predominant IBS
- •Symptom onset after an apparent episode of acute gastroenteritis
- •Symptoms of > 3 months duration
- •Normal endoscopic appearance of the colonic mucosa
- •Negative markers for celiac disease and inflammatory bowel disease.
- •Normal thyroid function and serum calcium levels.
- •Must have served in the military or reserves during the time of Operation Desert Storm (August 1990 to May 1991)
排除标准
- •Clinically significant cardiac, pulmonary, hepatic or renal dysfunction
- •History of/or presence of systemic malignancy
- •Current evidence of any gastrointestinal disorder such as celiac disease or inflammatory bowel disease (i.e. Crohns disease or ulcerative colitis)
- •Current effects of drug or alcohol abuse
- •Investigator perception of patients inability to comply with study protocol
- •Unstable psychiatric disease
- •Recent change in gastrointestinal medications
- •Subjects with a positive pregnancy test
- •Subject is currently participating in another research protocol that could interfere or influence the outcome measures of the present study
研究组 & 干预措施
Treatment Group
These patients have IBS and are receiving the rifaximin.
干预措施: Rifaximin (Drug)
Placebo group
These patients have IBS and are receiving the placebo.
干预措施: Placebo (Drug)
结局指标
主要结局
Global Improvement Scale
时间窗: Measured for seven days at the end of 2 weeks treatment and average score is calculated
Improvement in Irritable Bowel Syndrome symptoms post treatment is measured. This scale is not measured at baseline. Participants are asked if their symptoms improved or got worse and to rate it on a scale of 1- 7 for seven days. Average score for 7 days is calculated. The Global improvement scale ranges from 1- 7. Score of 1-3 means the IBS symptoms got worse, 4 means no change and 5-7 means improvement in the IBS symptoms.
次要结局
- Change in Stool Frequency (Number of Bowel Movements Per Day)(2 weeks)
- Change in Abdominal Pain With Bowel Movement(2 weeks)
- Change in Stool Consistency(2 weeks)
- Change in Bloating(2 weeks)
- Change in Bowel Urgency(2 weeks)