Physiologic Characteristics of Traditional Chinese Medicine Based IBS Subgroups

描述(申请人提供)：背景：肠易激综合征(IBS)是一种常见的慢性胃肠道(Gl)疾病，在没有可检测到的器质性原因的情况下，定义为腹痛或与肠道习惯改变相关的不适的反复症状。虽然许多IBS患者有肠外症状，但在传统模式下通常不考虑这些症状。部分由于缺乏有效的治疗方法，30%-40%的IBS患者转向补充和替代医学(CAM)治疗，而不是常规治疗，或除了传统治疗之外。与西方方法不同，中医将IBS患者视为一个不同的人群，他们的Gl症状是更广泛的潜在多系统失调造成的许多表现之一。在失调的中医模式中，患者被分为既有Gl症状又有肠外症状的亚组。针灸和草药等中医疗法针对的是这些特定的模式。此外，中医证型与IBS的常见表现以及应激神经生物学的新兴概念有惊人的相似之处，特别是等静和等静负荷。尽管它在中医范式中扮演着核心角色，但很少有研究探索调控失调模式的本质。目的：基于大量的初步数据，本研究试图通过检验以下假设来科学地验证中医证型：1)中医证型可以表现为与应激反应的特定变化相关的不同的病理生理模式，2)中医证型可以通过选择症状项来区分。方法：在目标1中，我们将评估情感、疼痛、自主神经和神经内分泌对内脏和躯体疼痛刺激的反应，以确定反映应激反应改变的两种不同模式(过度和不足)(分别为等静和等静负荷)。在目标2中，我们将评估患者对选定症状项的自我报告与患者对特定中医证型的中医专家诊断的相关性。结论：如果这些假说是正确的，它有力地证实了IBS的中医失调模式的存在，支持IBS是一种与当前特征相反的异质性、多系统的疾病，并为新的诊断和治疗方法提供了基础。鉴于传统方法治疗IBS等多系统功能障碍的结果令人失望，这可能为这些具有挑战性的疾病的分类和治疗提供令人兴奋的见解和贡献。

DESCRIPTION (provided by applicant): Background: Irritable Bowel Syndrome (IBS) is a common chronic gastrointestinal (Gl) disorder defined by recurrent symptoms of abdominal pain or discomfort associated with alterations in bowel habits, in the absence of a detectable organic cause. Though many IBS patients have extraintestinal symptoms, these are generally not considered under the conventional paradigm. Partly from the lack of effective therapies, 30- 40% of IBS patients turn to complementary and alternative medical (CAM) therapies instead of, or in addition to, conventional treatment. Unlike the western approach, Traditional Chinese Medicine (TCM) views IBS patients as a heterogeneous population whose Gl symptoms are one of many manifestations resulting from a broader underlying multisystemic dysregulation. In TCM patterns of dysregulation, patients are classified into subgroups incorporating both Gl and extraintestinal symptoms. TCM therapies like acupuncture and herbs target these specific patterns. Further, TCM patterns show striking similarity to common presentations of IBS and to emerging concepts of stress neurobiology, particularly allostasis and allostatic load. Despite its core role in the TCM paradigm, few studies explore the nature of patterns of dysregulation. Aims: Building on extensive preliminary data, this proposal seeks to scientifically validate TCM patterns by testing the following hypotheses: 1) TCM patterns can be characterized by distinct pathophysiologic patterns related to specific alterations in stress responsiveness, and 2) TCM patterns can be distinguished by select symptom items. Methods: In Aim 1, we will assess affective, pain, autonomic and neuroendocrine responses to visceral and somatic pain stimuli to identify two distinct patterns (EXCESS and DEFICIENCY) reflecting altered stress responsiveness (allostasis and allostatic load, respectively). In Aim 2, we will assess correlation between patient self-report of select symptom items and TCM expert diagnosis of patients to specific TCM patterns. Conclusions: If these hypotheses are correct, it strongly validates the existence of TCM patterns of dysregulation in IBS, supports that IBS is a heterogeneous, multisystemic disorder contrary to current characterizations, and provides the basis for novel diagnostic and treatment approaches. Given the disappointing results with conventional approaches to multisystemic functional disorders like IBS, this may provide exciting insights and contributions to the classification and treatment of these challenging disorders.