Defecation mechanisms and subtyping of constipation patients with Fecobionics

Fecobionics对便秘患者的排便机制和分型

• 批准号: 10211784
• 负责人: Hans Gregersen
• 金额: $ 64.56万
• 依托单位: CALIFORNIA MEDICAL INNOVATIONS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10211784
• 关键词: Affect; Anal canal; Anus; Area; Barium; Biomechanics; Chronic; Circular layer of muscularis propria of anal canal; Colorectal; Conflict (Psychology); Constipation; Data; Defecation; Defecography; Defect; Development; Devices; Diagnosis; Diagnostic; Diagnostic tests; Disease; Etiology; Event; Expenditure; External anal sphincter structure; Feces; Friction; Functional disorder; Future; Geometry; Goals; Health; Health Care Costs; Human; Incidence; Innovative Therapy; Intra-abdominal; Knowledge; Laboratories; Lead; Length; Location; Manometry; Maps; Medicine; Methods; Modality; Motor; Muscle; North America; Patients; Pattern; Pelvic Floor Muscle; Peristalsis; Persons; Physiological; Physiology; Play; Population; Privatization; Process; Property; Radiation; Records; Rectum; Reflex action; Relaxation; Research; Resolution; Risk; Role; Sensory; Shapes; Skeletal Muscle; Smooth Muscle; Sphincter; Stress; Symptoms; System; Test Result; Testing; Therapeutic; Thinking; Time; Treatment outcome; Valsalva Maneuver; Wireless Technology; abdominal pressure; abdominal wall; anorectal disorder; biomechanical model; cell motility; clinical decision-making; cost; driving force; improved; insight; laxative; mathematical model; motility disorder; novel; outcome prediction; pressure; rectal; sphincter ani muscle structure; symptom treatment; tool; treatment strategy; vector; viscoelasticity

ABSTRACT Chronic constipation (CC) is a common condition that affects up to 25% of the population in North America with rising incidence that poses a major burden on the healthcare cost. The pathophysiology of this condition is poorly understood and consequently there are inadequate treatments. The significant problems are, 1) incomplete understanding of the defecation reflex and 2) lack of physiologically relevant and practical diagnostic test for identifying the underlying mechanism(s). Current diagnostic tests provide incomplete and often conflicting information. Not surprisingly, results of these tests correlate poorly with symptoms and treatment outcomes. Our objective is to provide an improved understanding of the continence mechanisms and defecation patterns in healthy subjects and patients with CC using a novel Fecobionics device for mapping the geometric and manometric profiles during evacuation. Fecobionics is an electronic simulated stool that has the consistency and shape of normal stool. The device records pressures, cross-sectional area, orientation, bending, shape, and viscoelastic properties of the rectum and anal canal simultaneously. Our central hypothesis is that rectal peristalsis is a key component of the defecatory reflex which is not assessed in the current paradigm of diagnostic testing. The novel Fecobionics device will mimic the natural defecation and provide new mechanistic insights into the anorectal physiology and pathophysiology to facilitate the development of new treatments for CC. Fecobionics can provide complete picture of the normal defecation pattern (“signatures”) that includes rectal peristaltic reflex, deformability of the device and distensibility of the anal sphincters in healthy subjects and patients with various subtypes of CC. The Specific Aims are as follows: 1) Study the defecation dynamics in normal control subjects using Fecobionics. We will establish the role of rectal contraction/peristalsis in the normal evacuation process. 2) Define the defecatory patterns in patients with CC associated with defecatory disorders. We will determine if abnormalities of rectal contraction contribute to the CC. 3) Use a mathematical model of anorectal passage of Fecobionics for enhanced understanding of the normal and abnormal defecatory patterns, including the length-tension properties of the rectum and anal sphincter muscles. Our proposal seeks to shift current CC research by providing a stool surrogate for examining the physiologic parameters of defecation reflex using a novel device that will record, pressure, deformability, biomechanics, vectoral and topographic changes in the rectum and anal canal. The noted parameters will be recorded using a wireless Fecobionics device that can examine in detail the mechanistic underpinnings (stress and deformation) of defecation reflex/process in health and disease. The impact of this project is that it assesses a novel, safe, low cost, less invasive, low-risk, radiation-free device in its ability to provide better understanding of evacuation and continence mechanisms and thereby facilitate future development of innovative therapies. The improvement can lead to improvement in diagnostic and therapeutic modalities and reduce healthcare costs associated with anorectal disorders.

抽象的 慢性便秘（CC）是一种常见状况，影响北美多达25％的人口 上升的事件对医疗保健成本造成了重大燃烧。这种情况的病理生理是 理解不足，因此治疗不足。重大问题是1） 对排便反射的不完全理解和2）缺乏身体相关和实用 诊断测试用于识别基本机制。当前的诊断测试提供了不完整的 通常相互矛盾的信息。毫不奇怪，这些测试的结果与症状和 治疗结果。我们的目标是对持续机制有了改进的理解 使用新型的粪便设备进行映射的健康受试者和CC患者的排便方式 撤离期间的几何和分析图。繁殖力学是一种电子模拟凳子 正常粪便的一致性和形状。设备记录压力，横截面区域，方向， 直肠和肛管的弯曲，形状和粘弹性。我们的中心 假设是直肠蠕动是碎片反射的关键组成部分，在 当前的诊断测试范例。新颖的粪便设备将模仿自然的定义和 提供有关厌食生理学和病理生理学的新机械见解，以促进 开发CC的新治疗方法。繁殖学可以提供正常定义的完整图片 模式（“签名”），包括直肠蠕动反射，设备的可变形性和可不可 肛门括约肌和患有各种亚型CC的患者的肛门括约肌。具体目的是 以下内容：1）使用粪便学研究正常对照受试者的定义动力学。我们将建立 直肠收缩/蠕动在正常撤离过程中的作用。 2）定义缺陷模式 CC患者与恶魔疾病有关。我们将确定直肠收缩的异常 有助于CC。 3）使用粪便学的厌食直肠通道的数学模型来增强 了解正常和异常的缺乏型模式，包括 直肠和肛门括约肌肌肉。我们的建议旨在通过提供凳子来改变当前的CC研究 替代使用新型设备，以检查排便反射的生理参数 直肠和肛管的压力，变形，生物力学，矢量和地形变化。 指定的参数将使用无线繁殖设备记录，该设备可以详细检查 健康和疾病中排便反射/过程的机械基础（应力和变形）。这 该项目的影响是它评估了一种新颖，安全，低成本，侵入性较小，低风险，无辐射设备 它提供更好地理解疏散和持续机制的能力，从而托管 创新疗法的未来发展。改进可以改善诊断和 治疗方式并降低与肛门直肠疾病相关的医疗保健成本。