Clinical trial NCT03060642: The Microenvironment in Barrett's Esophagus
Official title: Application of the Microbiome and Microenvironment to Novel Non-Endoscopic Screening and Surveillance in Barrett's Esophagus
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Barrett Esophagus
Esophageal Adenocarcinoma
Keywords: Microenvironment
Microbiome
Screening
Barrett Esophagus
Esophageal Adenocarcinoma
Lead sponsor: Columbia University
Sponsor class: OTHER
Collaborators: name: Mayo Clinic
name: University of Pennsylvania
First posted: 2017-02-23
Enrollment: 155
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients with or without Barrett's esophagus already scheduled for upper endoscopy.

Brief summary: This study aims to elucidate the relationship between the microbiome, inflammation, and the microenvironment in Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), with the end goal of developing a non-endoscopic testing strategy based on pathogenic factors to identify patients at highest risk for EAC. To accomplish this the investigators will enroll 100 patients with known BE (50 with dysplasia or EAC) and 50 subjects without BE undergoing upper endoscopy. Prior to endoscopy each subject will undergo three minimally invasive potential screening and surveillance tests: saliva (oral microbiome), breath test (exhaled volatile organic compounds), and tethered capsule sponge sampling (methylated DNA markers). The study will evaluate these novel tests in combination with clinical and anthropometric factors to describe an optimal strategy for BE screening and monitoring.

Detailed description: The investigators will perform a multi-center cross-sectional study of patients with Barrett's esophagus, with and without associated dysplasia or cancer, and controls without BE. Enrollment of controls will be stratified based on use of proton pump inhibitors (PPIs). The investigators plan to enroll an approximate total of 150 subjects:

100 BE patients (with or without associated dysplasia or cancer)

* 50 subjects with non-dysplastic BE
* 50 subjects with BE and dysplasia or EAC

  50 controls
* 25 controls on PPIs (at least once daily)
* 25 controls not taking PPIs

Various tests will be performed and samples collected on the day of endoscopy. These tests include: saliva samples, electronic nose device testing, tethered capsule sponge testing, dietary questionnaires, and collection of blood and gastrointestinal biosamples. Analyses of this data and samples will then be performed to address the specific aims above.

Eligibility criteria: Inclusion Criteria:

(for BE patients)

* History of histologically confirmed BE, defined as endoscopically-suspected BE with intestinal metaplasia with goblet cells on esophageal biopsies
* BE length M≥2
* Taking proton pump inhibitors at least once daily for 3 months prior to enrollment
* Age ≥18

Exclusion Criteria:

* History of gastric cancer or esophageal squamous cell cancer
* History of gastric or esophageal surgery
* Use of antibiotics or systemic immunosuppressants within three months prior to the date of endoscopy (intranasal and inhaled steroids are allowed)
* Known untreated esophageal stricture or uninvestigated dysphagia
* Inability to give informed consent
* (BE patients only) History of prior endoscopic therapy for BE except a history of prior endoscopic mucosal resection (EMR) of focal lesions without subsequent ablative therapy is permitted

Primary outcomes:
measure: Oral and esophageal 16S rRNA gene sequencing
timeFrame: 1 day
Secondary outcomes:
measure: Esophageal tissue RNA-Seq
timeFrame: 1 day
measure: Gastric aspirate mass spectrometry
timeFrame: 1 day
Other outcomes:
Locations:
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
city: New York
country: United States
facility: Columbia University Medical Center
state: New York
city: Philadelphia
country: United States
facility: University of Pennsylvania
state: Pennsylvania
Study officials:
affiliation: Columbia University
name: Julian A. Abrams, MD, MS
role: PRINCIPAL_INVESTIGATOR
References: