New England Gastropareis Consortium: Neurobiology of Gastroparesis

新英格兰胃轻瘫联盟：胃轻瘫的神经生物学

• 批准号: 10001523
• 负责人: Braden Kuo
• 金额: $ 42.75万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-25 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10001523
• 关键词: Abdomen; Abdominal Pain; Antidepressive Agents; Anxiety; Brain; Brain imaging; Brain region; Caring; Chronic; Clinical; Clinical Research; Clinical Trials; Cognitive Therapy; Complex; Defect; Development; Diabetes Mellitus; Disease; Dyspepsia; Education; Enrollment; Enteral; Enteric Nervous System; Epidemiology; Frequencies; Functional disorder; Future; Gastric Emptying; Gastroparesis; Goals; Health; Liquid substance; Magnetic Resonance Imaging; Measurement; Measures; Medical; Mental Depression; Motion Sickness; Motor; Natural History; Nausea; Nausea and Vomiting; Neuraxis; Neurobiology; Neuropathy; New England; Pain; Pathology; Patients; Peripheral; Phenotype; Physiological; Physiology; Placebos; Quality of life; Radionuclide Imaging; Registries; Research; Satiation; Sensory; Severities; Site; Structural defect; Symptoms; Syndrome; Test Result; Testing; Therapeutic Intervention; Therapy trial; Time; Translating; United States National Institutes of Health; Visceral; Wireless Technology; capsule; cell motility; chronic pain; comorbidity; early satiety; experience; improved; insight; mindfulness; motor disorder; outcome forecast; persistent symptom; post intervention; recruit; reduce symptoms; success; symptomatic improvement; tertiary care

ABSTRACT Gastroparesis (GP) is defined as delayed gastric emptying in the absence of a gross structural abnormality with the symptoms chronic nausea and vomiting, early satiety, postprandial fullness, and abdominal distention. Pain or discomfort is frequently associated. A factor associated with improvement was anti-depressant use and factors associated with no symptom reduction included use of pain modulators, moderate to severe abdominal pain, and moderate to severe depression. The common theme of poor prognosis are factors which may arise from pathology that exist beyond just enteric motor function despite the fact that gastroparesis is indeed initially defined as an enteric motor disorder. Although the causes of gastroparesis can be multi-factorial, when the disease becomes chronic and the severity of the symptoms result in a high impact on Quality of Life (QOL), complex pathologies may begin to evolve in the enteric and central nervous system beyond just motor abnormalities contributing to other sensory defects. The neurobiology of these other factors needs to be explored further so that these insights can be translated into meaningful increases in treatment success in the moderate to severe gastroparetic patients. To accomplish these goals, we propose to create an additional site with the New England Gastroparesis Collaborative to join the NIH GR. The multi-center network will help recruit to our proposal to explore the peripheral and central neurobiology of gastroparesis and as well as help to conduct a Cognitive Behavioral Therapy (CBT) intervention to target these challenging pathologies. We plan to explore the relationships with gastroparesis symptoms, clinical co- comorbidities such as pain, depression, anxiety and catastrophization, and other GI physiological testing such as gastric emptying scitigraphy (GES), Wireless Motility Capsule (WMC), Electrogastrography (EGG) and Liquid Meal Satiety Drink Tests (SDT). We will perform a placebo controlled CBT trial in GP to examine the non- pharmacological impact of this treatment option on gastroparesis symptoms and the other clinical co-comorbidities such as pain, depression, anxiety and catastrophization. A subset of the CBT trial patients will undergo careful phenotyping pre/post intervention with brain MRI, AFT, and other GI physiological testing: GES, WMC, EGG and SDT to determine the impact of CBT on these physiologies. Characterization of these relationships or lack thereof can help guide future development of more targeted effective approaches in gastroparesis.

摘要 胃轻瘫（GP）定义为胃排空延迟， 肉眼结构异常，伴有慢性恶心和呕吐症状，早期 饱腹感、餐后饱胀感和腹胀。疼痛或不适经常 关联的.与改善相关的一个因素是抗抑郁药的使用和因素 与无症状减轻相关的包括使用疼痛调节剂，中度至 严重腹痛和中度至重度抑郁穷人的共同主题 预后是可能由不仅仅存在于肠内的病理引起的因素 尽管胃轻瘫最初确实被定义为肠麻痹， 运动障碍虽然胃轻瘫的原因可能是多因素的，当 疾病变成慢性的，症状的严重性导致对 生活质量（QOL），复杂的病理可能开始演变，在肠道和中枢 神经系统不仅仅是运动异常导致其他感觉缺陷。 这些其他因素的神经生物学需要进一步探索， 见解可以转化为治疗成功的有意义的增加， 中度至重度胃轻瘫患者。为了实现这些目标，我们建议 与新英格兰胃轻瘫协作组织创建一个额外的站点， 多中心网络将有助于招募我们的建议，以探索 胃轻瘫的外周和中枢神经生物学，以及帮助进行 认知行为疗法（CBT）干预针对这些具有挑战性的病理。 我们计划探讨胃轻瘫症状、临床并发症、 合并症，如疼痛、抑郁、焦虑和灾难化，以及其他GI 生理测试，如胃排空扫描（GES）、无线运动 胶囊（WMC），胃电图（EGG）和液体膳食饱腹感饮料试验（SDT）。 我们将在GP中进行安慰剂对照CBT试验，以检查非 这种治疗选择对胃轻瘫症状的药理学影响， 其他临床共病，如疼痛、抑郁、焦虑和灾难化。一 CBT试验患者的子集将在干预前/后进行仔细的表型分析 脑MRI、AFT和其他GI生理测试：GES、WMC、EGG和SDT， 确定CBT对这些生理的影响。表征这些 关系或缺乏关系可以帮助指导未来更有针对性的发展， 胃轻瘫的有效方法。