fMRI and Visceral Perception Upon Capsaicin Infusion

Study Overview
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Brief Summary
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Brain imaging has shown abnormal brain activations in response to visceral stimulation in patients with the Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD). To investigate the possible role of the Nucleus of the Solitary Tract (NTS), the primary relay station in the brainstem for vagal afferents, its activation in IBS and functional dyspepsia patients will be evaluated. Prior to this, an exploratory study in healthy volunteers will be conducted. This will be the first high magnetic field fMRI study (7T) evaluating the possible role of NTS activation in visceral abdominal pain. Moreover, this will be the first pharmacological fMRI study using duodenal capsaicin infusion as a chemical stimulus, which is more physiological than mechano-stimulation in the upper gastrointestinal tract.

Official Title
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Brain and Brainstem Activation Following Duodenal Nociceptive Stimulation With Capsaicin, an Exploratory High-resolution fMRI Study in Healthy Volunteers

Conditions
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Irritable Bowel Syndrome, Colonic Diseases, Functional, Dyspepsia, Gastrointestinal Diseases, Abdominal Pain, Visceral Pain

Intervention / Treatment
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* Other: Capsaicin
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Of female sex Based on medical history and previous examination, no gastrointestinal complaints can be defined. Age between 18 and 65 years. BMI between 18 and 30 kg/m2 Women in fertile age (<55 years old) must use contraception or be postmenopausal for at least two years. All subjects should be right-handed. Exclusion Criteria: Presence of metallic prostheses, pacemakers, metal clips on blood vessels, metal parts in the eye, an intrauterine device, metal braces, tattoos and/or other metal objects; History of major head trauma or head/brain surgery; History of claustrophobia; History of severe or chronic cardiovascular, respiratory, urogenital, gastrointestinal/ hepatic, hematological/immunologic, HEENT (head, ears, eyes, nose, throat), dermatological/connective tissue, musculoskeletal, metabolic/nutritional, endocrine, neurological/psychiatric diseases, allergy, major surgery and/or laboratory assessments which might limit participation in or completion of the study protocol; Use of medication, including vitamin and iron supplementation, except oral contraceptives, within 14 days prior to start of the study; Major abdominal surgery interfering with gastrointestinal function (uncomplicated appendectomy, cholecystectomy and hysterectomy allowed, and other surgery upon judgment of the principle investigator); Pregnancy, lactation, wish to become pregnant; High alcohol consumption (>15 alcoholic consumptions per week); Using drugs of abuse; Self-admitted HIV-positive state; Known allergic reaction to capsaicin; High intake of spicy (capsaicin containing) food (meaning an estimated intake of > than 1.5mg/day), due to possible desensitization of the capsaicin receptor TRPV1 (see further below); Administration of investigational drugs or participation in any scientific intervention study which may interfere with this study (to be decided by the principle investigator), in the 180 days prior to the study; Any evidence of structural brain abnormalities examined by anatomical MRI will lead to exclusion.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Duodenal capsaicin infusion<br>Through a naso-duodenal tube, a capsaicin solution will be infused into the duodenum. | Other: Capsaicin<br> <br> * Other names: Capsaicin oleoresina solution infusion into the duodenum.;|
| Placebo Comparator: Placebo (saline)<br>Through a naso-duodenal tube, a saline solution will be infused into the duodenum. | Other: Placebo<br> <br> * Other names: Saline infusion into the duodenum;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Activation of the Nucleus of the Solitary Tract | the BOLD (Voxel-wise blood oxygenation level dependent) signal activity in the Nucleus of the Solitary Tract during capsaicin infusion compared to placebo | During duodenal capsaicin and placebo infusion between t=0 and and t=38 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Activity and connectivity in the Cingulate Cortex, Insula, Thalamus, Prefrontal Cortex, Primary and Secondary Somatosensory Cortex, Amygdala, PAG | the functional BOLD signal activity in the above-mentioned brain structures during capsaicin infusion compared to placebo | During duodenal capsaicin and placebo infusion between t=0 and and t=60 minutes | 
| Questionnaire for pain (Visual Analogue Scores) | Scores range from 0 [no pain] to 10 [worst possible pain]. | During capsaicin and placebo infusion between t=0 and and t=38 minutes | 
| Questionnaire for depression and anxiety | Hospital Anxiety and Depression Scale (HADS). Has 14 items (7 for depression, 7 for anxiety) with a 4 points likert scale (0-3). Scores for depression and anxiety range from 0-21 and studies identified 8 as the cutoff-point. | During the test day, before scanning | 
| Questionnaire for depression | PHQ-9 scores (patient health questionnaire). The questionnaire has 9 items with a 4 points likert scale (0-3) and a total score of 27. A total score of 0-4 indicates none to minimal depressive symptoms, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. | During the test day (= day 1), before scanning | 
| Questionnaire for personality trait | BIG FIVE Inventory, the Big Five Inventory (BFI) survey that measures the big five dimensions of personality (extraversion, neuroticism, consciousness, agreeableness, and openness to experience). The questionnaire has 44 items. | During the test day (= day 1), before scanning | 
| Questionnaire for quality of life | SF-36 (quality of life) scores, The Short Form (36) Health Survey questionnaire of 36 items, scale 1-6, generates a physical and a mental QoL component summary. | During the test day (= day 1), before scanning | 
| Questionnaire for current affect scores | PANAS-SF (current affect) scores, Positive and Negative Affect Schedule. This is a 20 item questionnaire (scale 1-5) total scores can range from 10 - 50, with higher scores representing higher levels of positive affect. | During the test day (= day 1), before scanning | 
| Questionnaire for current pain | Brief Pain Inventory (BPI) scores, The BPI gives two main scores: a pain severity score and a pain interference score. The pain severity score is calculated from the four items about pain intensity. Each item is rated from 0, no pain, to 10, pain as bad as you can imagine, and contributes with the same weight to the final score, ranging from 0 to 40. The pain interference score corresponds to the item on pain interference. The seven sub- items are rated from 0, does not interfere, to 10, completely interferes, and contributes with the same weight to the final score, ranging from 0 to 70. | During the test day (= day 1), before scanning | 
| Questionnaire for anxiety | GAD-7 scores, for screening and severity measuring of generalized anxiety disorder (GAD). GAD-7 has seven items, 0-3 scale. | During the test day (= day 1), before scanning | 
| Questionnaire for the assessment of Gastrointestinal symptom scores | Scores of the GSRS, scale 1-7, generates subscores for abdominal pain, reflux, diarrhea, constipation, indigestion | During the test day (= day 1), before scanning | 
| Questionnaire for the assessment of Gastrointestinal symptom scores | Scores of the GSRS-IBS, scale 1-7, generates subscores for abdominal pain, bloating, constipation, diarrhea, satiety. | During the test day (= day 1), before scanning | 
| Questionnaire for the assessment of early life traumata | Scores of the ETISR-SF, The Early Trauma Inventory Self Report - Short Form comprises of 27 items, divided into four dimensions (general trauma, physical abuse, emotional abuse and sexual abuse) and scored on a dichotomous scale (Yes/No). | During the test day (= day 1), before scanning | 
| Questionnaire for the assessment of gastrointestinal specific anxiety | Scores of the Visceral Sensitivity Index, a 15 item questionnaire, scale 1-6, assesses gastrointestinal (GI)-specific anxiety. | During the test day (= day 1), before scanning | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Magnetic Resonance Imaging, Brainstem, Solitary Nucleus, Visceral Nervous System, Transient Receptor Potential Channels