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This is an observational study, which aims to compare the outcomes of ambulatory gastrointestinal investigations with physical activity using accelerometry. An ambulatory study refers to one in which the patient is monitored freely, often outside of the hospital environment. For this the investigators will use a lightweight (7.4g) tri-axial accelerometer worn behind the ear.
Hypothesis 1 There is no change in the amount or nature of physical activity taken by patients during ambulatory oesophageal pH monitoring or capsule endoscopy.
Hypothesis 2 There is no correlation between physical activity levels and speed of gastrointestinal transit.
For capsule endoscopy, the investigators are interested in how physical activity affects the speed of capsule transit through the GI tract. Capsule endoscopy involves a patient swallowing a pill which contains a camera, in order to image the parts of the bowel that a conventional endoscope cannot reach. A rapid transit may result in insufficient mucosal visualisation, which would reduce the sensitivity of the investigation.
For oesophageal pH monitoring, it is essential that the patient behaves as they would normally to produce measurements that represent a standard day. Using accelerometry, the investigators can compare the amount, and nature, of physical activity taken throughout the investigation to that of the preceding day, or week. In addition, further analysis of motion data captured will allow us to correlate specific activities and body orientation with pH readings to get a better insight into the pathophysiology of a patient's condition.
The studies will be conducted over 6-9 months in Imperial College Trust's medical outpatient service. All patients undergoing capsule endoscopy or ambulatory oesophageal monitoring will be asked to consider participating. Patients will receive the eAR sensor up to 2 days before their investigation, and will be asked to wear it until the end of their investigation (not whilst sleeping). Capsule endoscopy normally takes less than 12 hours, and pH monitoring takes between 24 and 48 hours. Participation makes no difference to the standard or type of care that they will receive, the sensor data is additional.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Capsule endoscopy | |||
| 24 hour oesophageal pH study |
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| Measure | Description | Time Frame |
|---|---|---|
| Physical Activity Change (%) | The primary outcome measure is amount of physical activity undertaken by participants throughout the study period. Participant motion data will be collected using a tri-axial accelerometer in the eAR sensor. Signal processing methods will be used to produce an activity index in the form of a numerical value, from the raw data. Activity levels were grouped at 1- minute intervals into restful, low, moderate or high intensity activity. Activity levels were calibrated for each participant, classifying activity into quartiles, where the most inactivity was labelled 'Restful', 2nd quartile 'low intensity', 3rd quartile 'moderate intensity' and upper quartile 'high intensity'. This provided a personalised activity profile with which to compare activity during the investigation. | Difference between baseline (2 days average) and test day (during pH monitoring) |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Relative Intensity of Daily Activities (%) | Measuring the changes in restful (activity equivalent to sitting), low (activity equivalent to a slow walk), moderate (activity equivalent to a brisk walk) and high intensity activity (activity equivalent to running). Including subject-specific activity intensity quartiles, were calculated and compared. | Difference between baseline (2 days average) and test day (during pH monitoring) |
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Inclusion Criteria:
Exclusion Criteria:
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Those who have been advised to undergo 24 hour oesophageal pH monitoring, or capsule endoscopy (from GI outpatients clinic)
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| Name | Affiliation | Role |
|---|---|---|
| Richard M Kwasnicki, BSc Hons | Imperial College London | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Imperial College Healthcare NHS Trust | London | W2 1NY | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25625191 | Result | Kwasnicki RM, Ley Greaves R, Ali R, Gummett PA, Yang GZ, Darzi A, Hoare J. Implementation of objective activity monitoring to supplement the interpretation of ambulatory esophageal PH investigations. Dis Esophagus. 2016 Apr;29(3):255-61. doi: 10.1111/dote.12312. Epub 2015 Jan 27. |
| Label | URL |
|---|---|
| Link to paper showing results of study | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | Capsule Endoscopy | A pill camera used for imaging the small bowel |
| FG001 | 24 Hour Oesophageal pH Study | Patients wore the accelerometer before and during the ambulatory oesophageal pH test for activity levels to be recorded and compared. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Capsule Endoscopy | A pill camera used for imaging the small bowel |
| BG001 | 24 Hour Oesophageal pH Study | Patients wore the accelerometer before and during the ambulatory oesophageal pH test for activity levels to be recorded and compared. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Physical Activity Change (%) | The primary outcome measure is amount of physical activity undertaken by participants throughout the study period. Participant motion data will be collected using a tri-axial accelerometer in the eAR sensor. Signal processing methods will be used to produce an activity index in the form of a numerical value, from the raw data. Activity levels were grouped at 1- minute intervals into restful, low, moderate or high intensity activity. Activity levels were calibrated for each participant, classifying activity into quartiles, where the most inactivity was labelled 'Restful', 2nd quartile 'low intensity', 3rd quartile 'moderate intensity' and upper quartile 'high intensity'. This provided a personalised activity profile with which to compare activity during the investigation. | Due to significant differences in expected and actual recruitment for the capsule endoscopy arm (i.e. 1 subject), raw data collected were not analysed to produce activity metrics. | Posted | Mean | Standard Deviation | Percentage change in activity | Difference between baseline (2 days average) and test day (during pH monitoring) |
|
2 days
No adverse events were anticipated from participation in this study.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Capsule Endoscopy | A pill camera used to image the small bowel. | 0 |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Richard Mark Kwasnicki | Imperial College London | 07851759471 | rmk107@ic.ac.uk |
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| ID | Term |
|---|---|
| D005764 | Gastroesophageal Reflux |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D015154 | Esophageal Motility Disorders |
| D003680 | Deglutition Disorders |
| D004935 | Esophageal Diseases |
| D005767 | Gastrointestinal Diseases |
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| BG002 | Total | Total of all reporting groups |
| Years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Description |
|---|
| OG000 | Capsule Endoscopy | A pill camera used for imaging the small bowel. |
| OG001 | 24 Hour Oesophageal pH Study | Patients wore the accelerometer before and during the ambulatory oesophageal pH test for activity levels to be recorded and compared. |
|
|
| Secondary | Change in Relative Intensity of Daily Activities (%) | Measuring the changes in restful (activity equivalent to sitting), low (activity equivalent to a slow walk), moderate (activity equivalent to a brisk walk) and high intensity activity (activity equivalent to running). Including subject-specific activity intensity quartiles, were calculated and compared. | Raw data captured for capsule endoscopy group not analysed to produce activity metrics due to insufficient numbers recruited (i.e. 1 subject). | Posted | Mean | Standard Deviation | Percentage change in activity | Difference between baseline (2 days average) and test day (during pH monitoring) |
|
|
|
| 1 |
| 0 |
| 1 |
| 0 |
| 1 |
| EG001 | 24 Hour Oesophageal pH Study | Patients wore the accelerometer before and during the ambulatory oesophageal pH test for activity levels to be recorded and compared. | 0 | 20 | 0 | 20 | 0 | 20 |
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| D004066 | Digestive System Diseases |
| D001519 | Behavior |
| Title | Measurements |
|---|---|
|
| High |
|