New England Gastropareis Consortium: Neurobiology of Gastroparesis

摘要 胃轻瘫(GP)的定义是胃排空延迟。 大体结构异常，早期表现为慢性恶心和呕吐 饱腹感、餐后饱腹感和腹胀。疼痛或不适经常是 关联的。与改善相关的一个因素是抗抑郁药的使用和因素 与无症状缓解相关的包括使用疼痛调节剂，中度至 严重的腹痛，以及中度到重度的抑郁。贫穷的共同主题 预后是指可能出现在肠道以外的病理因素。 运动功能，尽管胃轻瘫最初确实被定义为肠性瘫痪 运动障碍。虽然胃瘫的原因可能是多因素的，但当 疾病变得慢性，症状的严重程度会对 生活质量(QOL)，复杂的病理可能开始在肠道和中枢演变 神经系统不只是运动异常，还会导致其他感觉缺陷。 这些其他因素的神经生物学需要进一步研究，以便这些 洞察力可以转化为有意义的治疗成功率的增加 中重度胃轻瘫患者。为达致这些目标，我们建议 与新英格兰胃瘫协作组一起创建一个额外的站点以加入 美国国立卫生研究院多中心网络将有助于招募我们的建议，以探索 胃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)干预以针对这些具有挑战性的病理。 我们计划探讨胃轻瘫症状与临床的关系。 疼痛、抑郁、焦虑和灾难等共病，以及其他胃肠道疾病 生理测试，如胃排空坐骨神经造影(GES)、无线运动 胶囊(WMC)、胃电(EGG)和液体餐饱饮试验(SDT)。 我们将在全科医生中进行一项安慰剂对照CBT试验，以检查非 这种治疗方案对胃瘫症状和胃轻瘫的药理学影响 其他临床共病，如疼痛、抑郁、焦虑和灾难。一个 CBT试验患者的子组将在干预前/后接受仔细的表型鉴定 使用脑MRI、AFT和其他GI生理测试：GES、WMC、EGG和SDT以 确定CBT对这些生理的影响。对这些的描述 关系或缺乏关系有助于指导更有针对性的未来发展 胃轻瘫的有效治疗方法。

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.