Interstitial Cystitis/Painful Bladder Syndrome and Irritable Bowel Syndrome

间质性膀胱炎/膀胱疼痛综合症和肠易激综合症

• 批准号: 7571849
• 负责人: Satish SC Rao
• 金额: $ 15.01万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7571849
• 关键词: Abdominal Pain; Address; Affect; Anterior; Anus; Ataxia; Autonomic nervous system; Bilateral; Biomechanics; Bladder; Brain; Cerebral cortex; Chronic; Data; Devices; Discriminant Analysis; Disease; Distress; Electric Stimulation; Electrodes; Electromyography; Esthesia; Evoked Potentials; Feces; Fire - disasters; Functional disorder; Goals; Healthcare; Hypersensitivity; Insula of Reil; Interstitial Cystitis; Intestines; Irritable Bowel Syndrome; Lead; Magnetism; Manometry; Measures; Medial; Methods; Morphology; Motor; Motor Cortex; Motor Evoked Potentials; Neurons; Pain; Patients; Pelvic Pain; Pelvic floor dysfunction; Pelvic floor structure; Perception; Peripheral; Peripheral Nervous System; Population; Positioning Attribute; Process; Property; Prosencephalon; Quality of life; Rectum; Regulation; Sacral nerve; Sensory; Sensory Thresholds; Side; Signal Transduction; Site; Somatosensory Cortex; Symptoms; Syndrome; Testing; Thalamic structure; Transcranial magnetic stimulation; Transcriptional Activation; Up-Regulation; Visceral; Woman; base; care burden; chronic pelvic pain; cingulate cortex; computerized; cranium; cytokine; desire; diaries; experience; hypothalamic-pituitary-adrenal axis; indexing; insight; multidisciplinary; novel; painful bladder syndrome; prospective; psychologic; rectal; rectum/anus; response; urinary

Interstitial cystitis (1C) and Irritable bowel syndrome (IBS) affect 15-30% of the US population, invariably women, and are characterized by overlapping symptoms of chronic pelvic pain, urinary and bowel dysfunction. Their pathophysiology is poorly understood. They impair quality of life and impose major health care burden. Most patients are dissatisfied with current therapies. IBS & 1C therapy fail because they do not remedy the underlying problem. Our goal is to investigate the neurobiologic mechanisms that cause 1C and IBS. Our preliminary studies in IBS reveal maladaptive neuroplastic changes within the central and peripheral nervous system, but the pelvic floor-brain neuromuscular axis in IC/IBS patients has not been examined. We hypothesize that bidirectional signaling in the brain-pelvic floor/gut axis is deranged in IC/IBS patients. We will test this by using a new, noninvasive and validated method of studying the brain-pelvic floor axis. We propose four specific aims: 1) Examine the hyperexcitability of the afferent-pelvic floor-brain axis in 66 patients with 1C, 66 patients with 1C and IBS and 30 healthy controls by measuring the cortical evoked potentials (CEP) and sensory thresholds after electrical stimulation of the rectum and anus. 2) Study the efferent brain-pelvic floor axis by stimulating the cortex with transcranial magnetic stimulation and record the anal and rectal motor evoked potentials (MEP). 3) Determine the locus for neuronal modulation i.e are the neuroenteric changes due to central or peripheral neuronal sensitization or both, by evoking anal and rectal MEPs after selectively stimulating the lumbar and sacral nerves bilaterally, and by comparing segmental with transcranial-induced MEPs. 4) Evaluate why IC/IBS patients experience bowel symptoms by assessing anorectal sensation and sensori-motor function and correlating bowel and bladder symptoms with anorectal hypersensitivity, rectal compliance and pelvic floor dysfunction. Our multidisciplinary, comprehensive approach will investigate the neurobiologic mechanisms of chronic pelvic pain in IC/IBS, and how they differ from 1C. Our studies will provide novel mechanistic insights regarding the pathobiology of these overlapping pain syndromes, which could have a significant impact on our understanding of 1C/IBS, and pave the way for mechanistic-based therapies.

间质性膀胱炎（1C）和肠易激综合症（IBS）影响15-30％的美国人口 妇女的特征是慢性骨盆疼痛，尿和肠的重叠症状 功能障碍。他们的病理生理学知之甚少。它们损害生活质量并实现重大健康 护理负担。大多数患者对当前疗法不满意。 IBS和1C治疗失败，因为它们没有 解决基本问题。我们的目标是研究导致1C和1C的神经生物学机制 肠易激综合症。我们在IBS中的初步研究揭示了中央和 外周神经系统，但是IC/IBS患者中的骨盆地板神经肌肉轴尚未 检查。我们假设在脑 - 骨盆底/肠道轴上的双向信号传导在IC/IBS中被扰乱 患者。我们将使用一种研究脑斜底层的新的，无创和经过验证的方法来测试这一点 轴。 我们提出了四个具体目的：1）检查传入 - 斜骨轴轴的过度刺激性 通过测量皮质诱发的66例1C患者，66例患者1C和IBS患者以及30例健康对照。 直肠和肛门电刺激后电位（CEP）和感觉阈值。 2）研究 通过通过经颅磁刺激刺激皮质并记录 肛门和直肠电机引起电位（MEP）。 3）确定神经元调节的基因座，即 由于中央或周围神经元的敏化或直肠肛门和直肠而导致的神经脑性变化或两者兼而有之 在选择性刺激双侧的腰神经和s骨神经之后，通过与分段进行比较 经颅引起的MEP。 4）评估为什么IC/IBS患者通过评估来体验肠症状 厌食直肠感觉和感官运动功能以及与肛门直肠症状相关的肠子和膀胱症状 超敏反应，直肠合规性和骨盆底功能障碍。 我们的多学科，全面的方法将研究慢性的神经生物学机制 IC/IBS中的骨盆疼痛，以及它们与1C的不同之处。我们的研究将提供新颖的机械见解 关于这些重叠疼痛综合征的病理生物学，这可能会对 我们对1C/IB的理解，为基于机械的疗法铺平了道路。