Utility of Pharmacogenomic Testing in Patients With Gastrointestinal Disorders

Study Overview
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Brief Summary
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Researchers are trying to learn more about how individuals break down and process specific medications based on their genes. Pharmacogenomics (PGx) is a new, specialized field within individualized medicine. PGx is the study of how genes may affect the body's response to, and interaction with, some prescription medications. Genes carry information that determines things such as eye color and blood type. Genes can also influence how individuals process and respond to medications. Depending on genetic make-up, some medications may work faster or slower or produce fewer side effects.

Official Title
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Utility of Pharmacogenomic Testing in Patients With Gastrointestinal Disorders

Conditions
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Gastrointestinal Diseases

Intervention / Treatment
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* Genetic: Pharmacogenomics (PGx) genetic testing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Rome IV criteria for functional nausea and vomiting disorders (chronic nausea vomiting syndrome, cyclic vomiting syndrome), abdominal bloating/distention, dyspepsia, irritable bowel syndrome, chronic abdominal pain, functional diarrhea, or chronic constipation. On 1 or more medications identified in Appendix 1 on a daily basis for at least six months. Symptoms of moderate or severe severity on either of these 2 instruments: For IBS-SSS, use moderate (175-300) or severe (> 300) IBS. For FD - Score ≥ 3 for any symptom on Nepean Dyspepsia Index. No prior pharmacogenomics assessment. Willingness to adjust medications based upon results of PGX testing. Patients must understand and provide written informed consent and HIPAA authorization prior to initiation of any study-specific procedures. Patients must have the ability to complete questionnaires by themselves or with assistance. Exclusion Criteria: Patients who decline to be evaluated by a mental health professional during their evaluation. Rumination syndrome, cannabinoid hyperemesis syndrome, patients with a significant GI disease process (e.g., intestinal pseudo-obstruction, severe gastroparesis, megacolon) which, in the opinion of the investigator, is likely irreversible. Patients who, in the opinion of the investigator, are likely to undergo another major therapeutic intervention during the next 6 months (e.g., surgery or pelvic floor retraining by biofeedback therapy). However, other changes (e.g., medications) will not preclude participation in the study. Patients with any of the following per history, and review of medical record prior to study entry: any psychotic disorders, bipolar disorders, or major cognitive disorders; any active substance use disorders, other than tobacco; currently active suicidal ideation; current treatment with electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS); discharge from a psychiatric inpatient hospital or intensive psychiatric outpatient program within 6 weeks prior to GI consultation. Patients who are unwilling or cannot, for any reason, adjust their medications.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Guided Group<br>Subjects treating physician will receive PGx results to facilitate clinical decisions | Genetic: Pharmacogenomics (PGx) genetic testing<br>* A buccal swab to collect cells from the inside the cheek<br>|
| Active Comparator: Unguided Group<br>Subjects treating physician will be blinded to PGx results and will receive standard medical care | Genetic: Pharmacogenomics (PGx) genetic testing<br>* A buccal swab to collect cells from the inside the cheek<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of subjects to have clinical management changes based on PGx results | Number of subjects that pharmacogenomic (PGx) results guided the clinical management of gastrointestinal disorders | 3 months | 
| Change in Irritable Bowel Syndrome (IBS) severity | Measured using the self-reported IBS severity scoring system (IBS-SSS) Questionnaire; 500 point continuous scale: 0= no symptoms to 500=maximum severity | Baseline, 3 months. 6 months | 
| Change in Irritable Bowel Syndrome Quality of Life | Measured using the self-reported Irritable Bowel Syndrome Quality of Life (IBS-QOL) survey; score ranges from 0 (poor QOL) to 100 (maximum QOL) | Baseline, 3 months. 6 months | 
| Change in symptom severity with dyspepsia | Measured using the self-reported Nepean Dyspepsia Index (NDI) questionnaire which consists of a symptom checklist that measures frequency (0-4), intensity (0-5) and bothersomeness (0-4) of 15 upper gastrointestinal symptoms. The average score for each symptom is derived by averaging scores for frequency, intensity, and bothersomeness. Scores of 3 respectively represent a frequency of 9 to 12 days/week, moderate intensity, and a bothersomeness of quite a bit. | Baseline, 3 months. 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in anxiety | Measured using the self-reported Generalized Anxiety Disorder-7 (GAD-7) questionnaire; score range 0-21 points, higher scores indicate worse symptoms | Baseline, 3 months, 6 months | 
| Change in Patient Health Questionnaire Score | Measured using the self-reported Patient Health Questionnaire (PHQ-9); score range 0-27 points, higher scores indicate worse symptoms | Baseline, 3 months, 6 months | 
| Change in general well-being | Measured using the self-reported Global Wellbeing Likert scale; subjects asked to rate their general health perception on a scale range of 1=Excellent, 2=Very Good, 3=Good, 4=Fair, 5=Poor | Baseline, 3 months, 6 months | 
| Change in Pain score | Measured using the self-reported McGill Pain score; score range 0-78; higher scores indicate worse pain | Baseline, 3 months, 6 months |