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Esophageal AchalasiaNCT06027190

Randomized Controlled Study of Optical 3D Navigated Repetitive Transcranial Magnetic Stimulation for Achalasia.

A study testing Repetitive transcranial magnetic stimulation in people with Esophageal Achalasia and Transcranial Magnetic Stimulation, Repetitive, run by Zhang Nina at 1 site in China.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to investigate the clinical efficacy of repetitive transcranial magnetic stimulation in the treatment of achalasia in patients diagnosed with achalasia by comprehensive evaluation of clinical symptoms, HREM, and barium meal examination, optimize rTMS treatment parameters, and provide… Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
Repetitive transcranial magnetic stimulation
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
112 participants
Where
1 siteChina
Study dates
1 Jan 2024to 31 Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged more than 18 years old, less than 75 years old;
  • Clinical symptoms evaluation, HREM, esophageal barium meal examination confirmed the diagnosis of achalasia;
  • Willing to sign informed consent.

Who cannot join

  • Presence of metal hardware in close contact with the discharge coil (e.g., cochlear implant, internal pulse generator, or drug pump). Note: Cochlear implants include electrodes, magnets, loop antennas, and electronic chips under the scalp implanted in the cochlea;
  • Intracranial metal implants;
  • Patients with cardiac pacemakers, vagal nerve stimulation (VNS) systems, spinal cord stimulators, and deep brain stimulation implanted with pulse generators should be used with caution;
  • People at higher risk of noisy hearing loss and patients with hypoacusis symptoms should be used with caution;
  • Pregnancy;
  • Severe or recent heart disease;
Show all 11Show fewer
  • Personal history of epilepsy, use of known drugs that lower the seizure threshold, and other factors that may lower the seizure threshold (e.g., lack of sleep, infection, and alcohol abuse);
  • Increased intracranial pressure;
  • Acute phase of intracranial infection and hemorrhagic disease;
  • Contraindications to MRI examination or claustrophobia;
  • Refusal to sign informed consent.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

China1 site
  • Nanjing Drum Tower Hospital

    Nanjing, 210008

    Nina Zhang, +8618652782446, zhangnina@njglyy.com

Other trials in China

About this study

Official title: To Investigate the Clinical Efficacy of Optical 3D Navigation Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Achalasia, Optimize the Treatment Parameters, and Provide a Noninvasive Treatment Strategy for Achalasia

The goal of this clinical trial is to investigate the clinical efficacy of repetitive transcranial magnetic stimulation in the treatment of achalasia in patients diagnosed with achalasia by comprehensive evaluation of clinical symptoms, HREM, and barium meal examination, optimize rTMS treatment parameters, and provide an effective and noninvasive new treatment strategy for achalasia. The main questions it aims to answer are:

  1. To investigate the clinical efficacy of individualized treatment of achalasia with optical 3D navigation repetitive transcranial magnetic stimulation.
  2. Optimize rTMS parameters to achieve the best clinical treatment.

Participants will need to fill out the Eckardt score scale and SF-36 quality of life scale, undergo cranial T1 structural magnetic resonance for functional connectivity analysis, and select the brain region with the strongest positive functional connectivity to the DMV as the rTMS target. All patients were randomly divided into four groups: sham-rTMS group, 5Hz-rTMS group, 10Hz-rTMS group, and 30Hz-rTMS group, and each group received acute and chronic stimulation, respectively. In the acute stimulation stage, patients only need to do rTMS once, and HREM and HRV detection are given before and after rTMS (stimulation for 1s, interval for 4s, 10 pulses per second, receiving a total of 3000 pulses); in the chronic stimulation stage, patients receive 25 minutes of rTMS actual stimulation or sham stimulation each time, lasting for 20 times, which is completed within 30 days, and the actual stimulation parameters are the same as those of acute stimulation, and the sham stimulation coil is consistent with the appearance and sound of proper stimulation, but there is no substantial stimulation. High-definition esophageal manometry, timed barium meal, heart rate coefficient of variation, and serum neurotransmitters were performed before and after chronic stimulation. Finally, a weekly telephone follow-up was performed for 12 weeks, including Eckardt score and SF-36 quality of life scale.

Read the detailed description

Study hypothesis: By analyzing the strongest resting-state functional connectivity between DMV and right precentral gyrus, left postcentral gyrus, and left brain leads in achalasia patients, individualized rTMS treatment with optical 3D navigation was applied to relax LES and relieve the clinical symptoms of dysphagia.

Statistical methods: SPSS 25.0 software was used to process the data, symptom score, manometry parameters, serum transmitters and other quantitative indicators. If they met the normal distribution, they were expressed as Mean ± SD. The t-test was performed for the comparison between the two groups; if they did not obey the normal distribution, the median (quartile) was used for statistical description. The rank sum test was used for the comparison between the two groups. Enumeration data were described using number of cases (percentage), and X2 test, corrected X2 test, or Fisher exact test were performed for comparison between the 2 groups.

Being tested
Repetitive transcranial magnetic stimulation, Sham
Keywords
Achalasia, rTMS, fMRI, Non-invasive
Medical subject headings
Esophageal Achalasia, Vagus Nerve Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Repetitive transcranial magnetic stimulationDevice

    Intervention Name and Specification

    1. Transcranial magnetic stimulator (M-100 Ultimate, Yingzhi Technology Co., Ltd., China) .
    2. 70-mm-diameter figure-of-eight coil (BY90A, Yingzhi Technology Co., Ltd., China). 3) Placebo coil (Magstim Company, Whitland, UK): the appearance and sound were consistent with the true coil, but no current stimulation was produced.
  • ShamDevice

    Placebo coil (Magstim Company, Whitland, UK):

Study groups in NCT06027190
Study groupRoleWhat they receive
Sham groupSham comparatorIntervention Name and Specification: Placebo coil (Magstim Company, Whitland, UK): looks and sounds consistent with true coil but does not produce current stimulation.
Receives: Device: Sham
rTMS groupExperimental1. 5Hz-rTMS group 2. 10Hz-rTMS group 3. 30Hz-rTMS group Intervention Name and Specification: 1. Transcranial magnetic stimulator (M-100 Ultimate, Yingzhi Technology Co., Ltd., China) 2. 70 mm diameter figure-of-eight coil (BY90A, Yingzhi Technology Co., Ltd., China). Each group received acute and chronic stimulation, respectively. In the acute stimulation stage, patients only needed to do rTMS once, and HREM and HRV were administered before and after rTMS; in the chronic stimulation stage, patients received 25 minutes of rTMS true stimulation each time a day for 20 times, which was completed within 30 days, and the true stimulation parameters were the same as those of acute stimulation.
Receives: Device: Repetitive transcranial magnetic stimulation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Eckardt score

    The Eckardt scoring system is used to assess the severity of symptoms, with 0 to 1 in grade 0, 2 to 3 in grade I., 4 to 6 in grade II., and > 6 in grade III. The more severe the symptoms, the higher the score, and can also be used for efficacy assessment.

    Measured: Measured immediately after intervention.

  2. Real-time esophageal barium meal examination

    The severity of the patient 's condition and the therapeutic effect were evaluated by defining the height and maximum width of the residual barium area.

    Measured: Measured immediately after intervention.

  3. High-resolution esophageal manometry(HREM)

    HREM is the gold standard for the diagnosis of achalasia of cardia (AC), which can assess the relaxation ability of the lower esophageal sphincter (LES) and the contraction ability of the esophageal body. HREM dynamically collects the mean pressure data of multiple parts of the whole esophagus in real time, and converts the linear manometry pattern into color pressure topography. The basic manometry parameters include integrated relaxation pressure (IRP) and lower esophageal sphincter pressure (LESP), which can more truly reflect the relaxation function of the gastroesophageal junction (EGJ) and are the key indicators for the diagnosis of AC.

    Measured: Measured immediately after intervention.

Secondary outcomes (2)
  1. Heart rate variability assessment

    Dynamic electrocardiogram recording analysis of sympathetic vagal activity.

    Measured: Measured immediately after intervention.

  2. Neurotransmitter detection analysis

    Serum ACh, NO and VIP

    Measured: Measured immediately after intervention.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Sep 2023
  2. Study start1 Jan 2024 (estimated)
  3. Primary completion31 Dec 2026 (estimated)
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
In patients with achalasia diagnosed by clinical symptoms, HREM and barium meal examination, functional connectivity analysis of DMV with three brain regions (precentral gyrus, postcentral gyrus and insula) was performed by scanning T1 structural magnetic resonance imaging, and brain regions with the strongest positive functional connectivity with DMV were selected as individualized rTMS targets by optical 3D navigation. All patients were randomly divided into four groups: sham-rTMS group, 5Hz-rTMS group, 10Hz-rTMS group, and 30Hz-rTMS group, and each group received acute and chronic stimulation, respectively.
Masking
Single blind
Who is masked
Participant
Enrolment
112 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06027190
Sponsor's protocol ID
2023-160-02
Status last verified
Sep 2023
First submitted
31 Aug 2023
Last updated
21 Sep 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Pomenti S, Blackett JW, Jodorkovsky D. Achalasia: Diagnosis, Management and Surveillance. Gastroenterol Clin North Am. 2021 Dec;50(4):721-736. doi: 10.1016/j.gtc.2021.07.001. Epub 2021 Oct 2.

    PubMed 34717867
  • Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol. 2018 Jul;12(7):711-721. doi: 10.1080/17474124.2018.1481748. Epub 2018 Jun 8.

    PubMed 29804476
  • Mari A, Abu Baker F, Pellicano R, Khoury T. Diagnosis and Management of Achalasia: Updates of the Last Two Years. J Clin Med. 2021 Aug 16;10(16):3607. doi: 10.3390/jcm10163607.

    PubMed 34441901
  • Gregersen H, Lo KM. Pathophysiology and treatment of achalasia in a muscle mechanical perspective. Ann N Y Acad Sci. 2018 Dec;1434(1):173-184. doi: 10.1111/nyas.13711. Epub 2018 May 14.

    PubMed 29756656
  • Shiwaku H, Sato H, Shimamura Y, Abe H, Shiota J, Sato C, Ominami M, Sakae H, Hata Y, Fukuda H, Ogawa R, Nakamura J, Tatsuta T, Ikebuchi Y, Yokomichi H, Hasegawa S, Inoue H. Risk factors and long-term course of gastroesophageal reflux disease after peroral endoscopic myotomy: A large-scale multicenter cohort study in Japan. Endoscopy. 2022 Sep;54(9):839-847. doi: 10.1055/a-1753-9801. Epub 2022 Feb 16.

    PubMed 35172368
  • Schlottmann F, Neto RML, Herbella FAM, Patti MG. Esophageal Achalasia: Pathophysiology, Clinical Presentation, and Diagnostic Evaluation. Am Surg. 2018 Apr 1;84(4):467-472.

    PubMed 29712590
  • Goyal RK, Padmanabhan R, Sang Q. Neural circuits in swallowing and abdominal vagal afferent-mediated lower esophageal sphincter relaxation. Am J Med. 2001 Dec 3;111 Suppl 8A:95S-105S. doi: 10.1016/s0002-9343(01)00863-4.

    PubMed 11749933
  • Clyburn C, Travagli RA, Browning KN. Acute high-fat diet upregulates glutamatergic signaling in the dorsal motor nucleus of the vagus. Am J Physiol Gastrointest Liver Physiol. 2018 May 1;314(5):G623-G634. doi: 10.1152/ajpgi.00395.2017. Epub 2018 Jan 25.

    PubMed 29368945
  • Browning KN, Carson KE. Central Neurocircuits Regulating Food Intake in Response to Gut Inputs-Preclinical Evidence. Nutrients. 2021 Mar 11;13(3):908. doi: 10.3390/nu13030908.

    PubMed 33799575
  • Farre R, Sifrim D. Regulation of basal tone, relaxation and contraction of the lower oesophageal sphincter. Relevance to drug discovery for oesophageal disorders. Br J Pharmacol. 2008 Mar;153(5):858-69. doi: 10.1038/sj.bjp.0707572. Epub 2007 Nov 12.

    PubMed 17994108
  • Hornby PJ, Abrahams TP. Central control of lower esophageal sphincter relaxation. Am J Med. 2000 Mar 6;108 Suppl 4a:90S-98S. doi: 10.1016/s0002-9343(99)00345-9.

    PubMed 10718459
  • Abrahams TP, Partosoedarso ER, Hornby PJ. Lower oesophageal sphincter relaxation evoked by stimulation of the dorsal motor nucleus of the vagus in ferrets. Neurogastroenterol Motil. 2002 Jun;14(3):295-304. doi: 10.1046/j.1365-2982.2002.00329.x.

    PubMed 12061915
  • Urban DJ, Roth BL. DREADDs (designer receptors exclusively activated by designer drugs): chemogenetic tools with therapeutic utility. Annu Rev Pharmacol Toxicol. 2015;55:399-417. doi: 10.1146/annurev-pharmtox-010814-124803. Epub 2014 Sep 25.

    PubMed 25292433
  • Roth BL. DREADDs for Neuroscientists. Neuron. 2016 Feb 17;89(4):683-94. doi: 10.1016/j.neuron.2016.01.040.

    PubMed 26889809
  • Magnus CJ, Lee PH, Bonaventura J, Zemla R, Gomez JL, Ramirez MH, Hu X, Galvan A, Basu J, Michaelides M, Sternson SM. Ultrapotent chemogenetics for research and potential clinical applications. Science. 2019 Apr 12;364(6436):eaav5282. doi: 10.1126/science.aav5282. Epub 2019 Mar 14.

    PubMed 30872534

Questions about this trial

What is this clinical trial studying?

A study testing Repetitive transcranial magnetic stimulation in people with Esophageal Achalasia and Transcranial Magnetic Stimulation, Repetitive, run by Zhang Nina at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 21 Sep 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Nina Zhang (18652782446, zhangnina@njglyy.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Eckardt score (time frame: Measured immediately after intervention.). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06027190, which also lists 19 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Sep 2023.

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