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Neonatal Gastro-Esophageal Reflux Disease (GERD) Management Trial (GMT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT02486263
Recruitment Status : Completed
First Posted : July 1, 2015
Results First Posted : July 29, 2020
Last Update Posted : July 29, 2020
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Ohio State University
Information provided by (Responsible Party):
Sudarshan Jadcherla, Nationwide Children's Hospital

Brief Summary:

The overall purpose of the investigator's study is to evaluate the causes of and treatment for feeding difficulty in infants with Gastro-esophageal Reflux Disease (GERD). New treatments can be possible only if the cause is known. Many infants have GERD and feeding difficulties, such as sucking and swallowing problems, vomiting, or delayed emptying of the stomach. Some of these infants have difficulty in protecting their airway during feeding or during reflux, and as a result can breathe fluid into their lungs or hold their breath. Most GERD treatments are done based on experience, but there is no scientific proof that these methods work for infants. GERD and feeding difficulties can lead to longer hospitalization and more stress for the family.

In this clinical trial, the investigators are developing new methods to help with diagnosis as well as defining better treatment strategies in relieving GERD and GERD complications.

Condition or disease Intervention/treatment Phase
Gastroesophageal Reflux Disease Other: Study Arm - acid suppression plus feeding bundle Other: Conventional arm - acid suppression only Not Applicable

Detailed Description:

Gastroesophageal reflux disease (GERD) and its troublesome complications constitute serious diagnostic and management challenges to the development of safe feeding and airway protection strategies among infants convalescing in the neonatal intensive care units; thus contributing to prolonged lengths of stay, recurrent hospitalizations, and death. GERD is frequently diagnosed by inadequate criteria, and the relative risks, benefits and indications of GERD therapies are unclear. Significant gaps in knowledge exist in understanding the complex causal or adaptive aerodigestive protective reflex mechanisms implicated in GERD in infants. The long-term goal is to improve digestive health, nutrition, and infant development through the design of simplified personalized treatment paradigms by better understanding the pathophysiology of aerodigestive reflexes.

The current objective is to conduct a prospective single center randomized blinded controlled trial comparing the short term effects of the investigators innovative feeding strategy bundle (study approach) versus standard feeding approach (conventional approach).

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 76 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Pathophysiology of the Aerodigestive Reflex in Infants: GERD Management Trial
Study Start Date : December 2012
Actual Primary Completion Date : March 31, 2020
Actual Study Completion Date : March 31, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: GERD

Arm Intervention/treatment
Experimental: Study
Treated with omeprazole. This group of subjects will have prescribed restricted feeding volumes, monitored feeding duration time and positioning restrictions
Other: Study Arm - acid suppression plus feeding bundle
  • Omeprazole 0.5-1.5 milligrams/kilogram/dose twice a day (BID)
  • Total fluid volume restriction (120-140 milliliters/kilogram/day)
  • Feeding duration over 30 minutes
  • Infant feeds with right side down
  • Infant is placed on back following feeds

Treated with omeprazole. This group of subjects will receive the current standard treatment for Gastro-esophageal reflux disease (GERD) which includes use of acid suppressive medication with no restrictions of the feeding volume, duration or positioning.
Other: Conventional arm - acid suppression only
-Omeprazole 0.5-1.5 milligrams/kilogram/dose twice a day (BID)

Primary Outcome Measures :
  1. CLINICAL OUTCOME OF FEEDING SUCCESS [ Time Frame: Up to 5 weeks after enrollment ]
    The primary endpoint is the feeding success defined as achieving full oral feeds (defined as no need for tube feeds to maintain hydration and nutrition) and/or a >/= 6 point decrease from baseline symptom score as described by the Infant-Gastro-Esophageal Reflux Questionnaire-Revised. The minimum score is 0 (no symptoms) and the maximum score is 42 (maximum symptoms). Any total score greater than or equal to 16 is considered abnormal.

  2. MOTILITY OUTCOMES: Presence of Esophageal Peristaltic Reflexes [ Time Frame: 5 weeks ]
    This is part of Aim 2 of this RCT, which is a mechanistic outcome designed to understand the reasons for the clinical outcome. Presence of peristaltic reflex mechanisms elicited upon esophageal provocation during esophageal manometry were compared within the groups, week-5 vs. week-0. Odds ratios (ORs) with 95% confidence interval (CI) are reported from Generalized Estimation Equation models.

Secondary Outcome Measures :
  1. CLINICAL OUTCOMES: Growth Outcome Measure [ Time Frame: at 5 weeks ]
    Growth: The investigators will measure and track weight growth velocity during the study period

  2. CLINICAL OUTCOME: Development Outcome Measures [ Time Frame: Up to 1 year age ]
    Feeding Milestones: The investigators will track feeding method at 1 year.

  3. CLINICAL OUTCOME: Respiratory Outcome Measures [ Time Frame: at discharge ]
    Supplemental oxygen requirement at discharge was recorded for both groups

Information from the National Library of Medicine

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Ages Eligible for Study:   34 Weeks to 60 Weeks   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Hospitalized infants with aerodigestive or GERD symptoms
  • Gestational age ≤42 weeks
  • Premature infants are eligible at 34 weeks postmenstrual age (PMA)
  • Enteral or Oral Fed
  • Average daily total feeding volume ≥ 150ml/kg/day
  • Room air or supplemental oxygen of ≤1 liter/minute (LPM) and/or ≤ 35% by nasal cannula

Exclusion Criteria:

  • Known genetic, metabolic or syndromic disease
  • Neurological diseases such as Grade 3 or 4 intraventricular hemorrhage (IVH) or intracranial hemorrhage (ICH) and perinatal asphyxia
  • Gastrointestinal malformations and surgical gastrointestinal conditions

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02486263

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United States, Ohio
The Research Institute at Nationwide Children's Hospital
Columbus, Ohio, United States, 43205
Sponsors and Collaborators
Sudarshan Jadcherla
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Ohio State University
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Principal Investigator: Sudarshan R Jadcherla, MD The Research Institute at Nationwide Children's Hospital
  Study Documents (Full-Text)

Documents provided by Sudarshan Jadcherla, Nationwide Children's Hospital:
Informed Consent Form  [PDF] January 17, 2019

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Sudarshan Jadcherla, Principal Investigator, Nationwide Children's Hospital
ClinicalTrials.gov Identifier: NCT02486263    
Other Study ID Numbers: 11-00734
R01DK068158 ( U.S. NIH Grant/Contract )
First Posted: July 1, 2015    Key Record Dates
Results First Posted: July 29, 2020
Last Update Posted: July 29, 2020
Last Verified: July 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Sudarshan Jadcherla, Nationwide Children's Hospital:
Additional relevant MeSH terms:
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Gastroesophageal Reflux
Esophageal Motility Disorders
Deglutition Disorders
Esophageal Diseases
Gastrointestinal Diseases
Digestive System Diseases