S1305 How Useful is Colonic Manometry in the Evaluation of Sensorimotor Dysfunction in Slow Transit Constipation (STC)?

Abstract

It is well known that patients with IBS have a high rate of co-morbid extra-intestinal symptoms.Traditional Chinese Medicine (TCM) views all illnesses as arising from global patterns of dysregulation and TCM predicts that despite similar symptoms, subgroups of IBS patients vary in important characteristics such as pain sensitivity and stress responses and these differences reflect different IBS pathophysiology and require different treatment. AIMS: To determine stress reactivity and pain sensitivity of IBS subgroups classified into TCM categories of Excess (Liver Qi stagnation), Deficiency (Spleen Qi deficiency) andOverlap (mixed symptoms). METHODS: 63 ROME III+ female IBS patients (Mean age= 36.38; SD +/13.0) were independently evaluated by two TCM practitioners and also filled out a TCM symptom questionnaire. Sensitivity to pressure pain at three body sites and autonomic responses to a psychological stressor were evaluated in a laboratory session. RESULTS: TCM practitioners agreed on 82.6% of diagnoses (excess=29, overlap=23, discrepancy=11 (not included in further analysis)) although there were not differences in IBS symptom severity by TCM subgroup. Older Excess subjects showed significantly less sensitivity to pressure pain compared to those with overlap (emeans: Excess =9.97+SE 1.08; Overlap = 10.33+ SE 1.06., p<.03). Similarly subjects with greater deficiency symptoms by questionnaire tended to have non-significantly higher pain sensitivity. 3) No significant differences were found in autonomic reactivity to the psychological stressor between the two groups based on TCM diagnosis. However, high deficiency scorers on the symptom questionnaire had a significantly greater increase in Diastolic BP during the stress tasks Pre-Speech (p= .005); Speech (p= 0.01); Math (p=0.03 but not in the initial or end baseline (p< .4). Similar findings were present for heart rate but no differences were found for a purely sympathetic measure, skin conductance. CONCLUSION: TCM based subgroups of IBS patients show differences in non-GI characteristics with greater pain sensitivity and cardiovascular stress responses in subjects showing increased deficiency symptoms. TCM subgroups may therefore reflect differences in underlying physiological responses relevant for IBS development and/or treatment. FundingNCCAM R21AT003221. S-225 AGA Abstracts S1307 Cognitive Behaviour Therapy's Role in the Treatment of Irritable Bowel Syndrome: Direct Effect on Symptoms or Operates via Mood ? Michael Jones, Natasha A. Koloski, Nick Talley BACKGROUND: A single previous paper on this topic found a direct effect of CBT on an IBS global symptom score that did not operate via patients' emotional state. This was quite controversial since under the biopsychosocial model of the relationship between bowel symptoms and mood, the expectation was that CBT's effect would be mediated by mood. Our data include more sensitive bowel symptom scales and measurements at additional time points AIMS: To determine the pathway of action of CBT on symptoms of irritable bowel syndrome METHODS: We evaluated direct pathways between CBT and change in IBS symptoms and indirect pathways that operate via mood state using structural equation modelling of the data set of a large number (n=105) of Rome I diagnosed people with IBS randomised to individual CBT (n=34), relaxation therapy (n=36) and usual medical care (n=35). The primary outcome was defined as change in IBS symptom score in terms of the distress, frequency, and impairment because of symptoms in the prior week according to the Bowel Symptom Severity Scale (BSSS). RESULTS: Direct pathways between CBT and changes in bowel symptom scores were not identified in our data. We do however find indirect pathways between CBT and bowel symptoms that operate via mood, most clearly through anxiety but to a lesser extent depression (Figure 1). Statistically significant pathways were identified that lead from CBT to changes during the first period in anxiety (B=1.74, p=0.02) thence to change in distress (B=0.64, p<0.01) and impairment (B=0.43, p=0.01). Change in frequency (period 1) was associated subsequent change in period 2 in depression (B=0.16, p<0.01). Change in distress (period 1) was associated with subsequent change in period 2 in anxiety (B=-0.23, p<0.01) and depression (B=-0.17, p=0.01). Change in frequency (B=0.44, p=0.01) and distress (B=0.35, p=0.03) in period 2 were associated with concurrent change in anxiety CONCLUSIONS: That CBT would directly affect bowel symptoms is counterintuitive and was not confirmed in our study. The present study suggests however that CBT may operate via changes in mood state, consistent with the biopsychosocial model. This finding suggests that CBT may have a useful role in the management of IBS.