Trial to Assess the Effects of an Antimicrobial Mouthwash on the Esophageal Microbiome

Pilot Randomized Trial to Assess the Effects of an Antimicrobial Mouthwash on the Esophageal and Gastric Microbiome

This is a randomized, open-label pilot study to assess whether treatment with chlorhexidine mouthwash can alter the esophageal and gastric cardia microbiome

Patients scheduled for upper endoscopy for clinical indications will be randomized to 3 weeks of either no treatment or use of twice daily chlorhexidine mouthwash leading up to the endoscopy. There will be 2-3 study visits, at Day 0 and Day 21, and for those subjects in the mouthwash arm, a final visit 1-2 weeks following the Day 21 visit. Subjects will be required to fast overnight prior to the visits on Days 0 and 21.

Inclusion Criteria:

• Age >18
• Scheduled for upper endoscopy for clinical indications
• No allergy or other contraindication to chlorhexidine

Exclusion Criteria:

• Use of proton pump inhibitors or H2 receptor antagonists within 1 month of enrollment. Acid suppressant medications raise the gastric pH and can dramatically alter the gastric and esophageal microbiome.
• History of upper gastrointestinal cancer
• History of histologically proven Barrett's esophagus
• History of antireflux or bariatric surgery, or other gastric or esophageal surgery
• Use of antimicrobial mouthwash within 1 month of enrollment
• Use of antibiotics or immunosuppressant medications within 3 months of enrollment
• Use of steroid inhalers or nasal sprays within 1 month of enrollment
• HIV or other immunosuppressed states or conditions (e.g. active malignancy)
• Pregnant or breast feeding
• Inability to give informed consent