Interaction between bolus transport mechanics and psychologic factors in modulating esophageal symptoms

食团输送力学与心理因素在调节食管症状中的相互作用

• 批准号: 10200798
• 负责人: LAURIE A KEEFER
• 金额: $ 39.08万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200798
• 关键词: Achalasia; Acids; Affect; Anatomy; Arousal; Autonomic nervous system; Behavior; Behavior Therapy; Benign; Biofeedback; Biofeedback Training; Biological Markers; Biomechanics; Bolus Infusion; Brain; Chest Pain; Chronic; Cognitive; Cognitive remediation; Complex; Data; Deglutition Disorders; Diagnosis; Disease; Economic Burden; Eosinophilia; Eosinophilic Esophagitis; Esophageal Diseases; Esophagus; Esthesia; Exercise; Fright; Functional disorder; Future; Gastroesophageal reflux disease; Generations; Goals; Health system; Heart; Histology; Hypersensitivity; Impairment; Incidence; Individual; Intervention; Lead; Link; Malnutrition; Measures; Mechanics; Mediating; Modeling; Monitor; Morbidity - disease rate; Muscle Contraction; Nervous System Physiology; Operating System; Outcome; Patient Outcomes Assessments; Patients; Perception; Phenotype; Physiological; Physiology; Population; Predictive Value; Process; Psychological Factors; Quality of life; Reporting; Research; Role; Severities; Signal Transduction; Statistical Models; Stress; Subconscious; Symptoms; Thinking; Time; Tissues; Training; Variant; Visceral; attentional bias; base; brief intervention; cell motility; cognitive process; design; effectiveness testing; experience; experimental study; fighting; flexibility; functional outcomes; heart rate variability; improved; improved functioning; improved outcome; mathematical model; mechanical properties; mortality; motor disorder; neuromuscular; novel; patient population; personalized intervention; population based; predictive modeling; psychologic; psychosocial; reduce symptoms; response; symptomatic improvement; time interval; treatment response

PROJECT SUMMARY Chronic digestive illness affecting the esophagus, including gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), achalasia and functional dysphagia are common and pose a significant economic burden. These are heterogeneous conditions whose pathophysiology occurs on a wide spectrum based on degree of abnormal acid exposure, motor dysfunction, bolus retention and degree of esophageal hypersensitivity. Symptom-to-physiology correlations are poor, indicating that other processes influence symptom experience. Almost half of patients continue to experience symptoms despite first-line treatments, leaving these patients with inadequate treatment options. There is a need for more personalized interventions targeting the bolus transit system that operate subconsciously to suppress the perception of bolus transit and muscle contraction. Centrally-mediated psychological processes such as esophageal hypervigilance, catastrophizing, and visceral hypersensitivity drive symptom experience, independent of acid exposure, motility function, or eosinophilia histology. Autonomic nervous system (ANS) arousal, the physiological “fight-or-flight” response to fear and hypervigilance, perpetuates these psychological processes. Heart rate variability (HRV), or the variation in time intervals between heart beats, serves as a biomarker for overall ANS functioning. Higher HRV is indicative of a greater ability to adapt to stressful situations, such as when experiencing esophageal symptoms. A less studied, yet important construct is cognitive flexibility, or the ability to appropriately shift thoughts and adapt behavior. Cognitive flexibility is a modifiable construct that if improved through training, can improve outcomes and prepare patients for behavioral treatments who may otherwise be poor responders. We aim to characterize the degree of cognitive flexibility in well-defined patient populations based on mechanical and physiological phenotypes derived from our biophysiologic modeling CORE. Then, we aim to evaluate heart rate variability biofeedback (HRVB), a novel intervention for these four patient groups. Patients will be stratified by cognitive flexibility level, with those identified as low undergoing Cognitive Remediation Therapy (CRT), a brief intervention using cognitive exercises to improve thinking strategies. We hypothesize applying HRVB to target ANS arousal in real-time, as the symptoms are being experienced, will be effective in increasing HRV, decreasing symptoms, and improving quality of life. We also expect HRVB will decrease esophageal hypervigilance in comparison to controls. We hypothesize CRT will be a feasible and acceptable intervention for esophageal patients, and will be associated with positive changes in cognitive flexibility, decreased symptoms, and improved quality of life. Finally, we aim to develop an integrative predictive model using biomarkers of esophageal distensibility, measures of HRV and measures of cognitive flexibility to define management and outcomes. The results will have implications for current and future behavioral interventions for individuals with chronic esophageal disorders.

项目摘要 影响食道的慢性消化疾病，包括胃食管反应疾病 （GERD），嗜酸性嗜酸性炎（EOE），adalasia和功能性吞咽困难是常见的，姿势A 巨大的经济负担。这些是异质疾病，其病理生理发生在A 广泛基于异常酸暴露，运动功能障碍，推注，保留和 食管超敏反应的程度。症状与生理学相关性很差，表明 其他过程会影响症状经历。几乎一半的患者继续出现症状 任务一线治疗，使这些患者的治疗选择不足。需要 针对推注交通系统的更个性化的干预措施，该系统在潜意识中运作以抑制 推注转移和肌肉收缩的感知。中央介导的心理过程 例如食管过度维护，灾难性和内脏超敏反应症状 经验，独立于酸性暴露，运动功能或嗜酸性粒细胞学学。自主神经 系统（ANS）唤醒，对恐惧和过度维护的物理“战斗或飞行”的反应，使人永存 这些心理过程。心率变异性（HRV）或心脏之间的时间间隔变化 Beats是整体ANS功能的生物标志物。较高的HRV表明能力更大 适应压力很大的情况，例如经历食管症状。一个较少的研究 重要的结构是认知灵活性，或者适当转移思想和适应的能力 行为。认知灵活性是一种可修改的结构，如果通过培训改进，可以改善 结果并为患者做好行为治疗的准备，否则可能是响应者较差的行为治疗。我们的目标 表征基于机械和机械和 源自我们的生物生理建模核心的生理表型。然后，我们的目标是评估心脏 利率变异性生物反馈（HRVB），这是这四个患者组的新干预。患者会 按认知灵活性水平分层，而认知补救措施则被确定为低 治疗（CRT），这是一种简短的干预，采用认知练习来改善思维策略。我们假设 随着症状的经历，将HRVB实时靶向ANS唤醒，将有效 增加HRV，减轻症状并改善生活质量。我们还希望HRVB会减少 与对照组相比，食管过度维护。我们假设CRT将是可行的，并且 食管患者可接受的干预措施，并将与 认知灵活性，改善症状和改善的生活质量。最后，我们旨在发展 使用食道令人讨厌的生物标志物，HRV测量和测量的综合预测模型 认知灵活性以定义管理和结果。结果将对 慢性食管疾病患者的当前和未来行为干预措施。