This R24 application requests infrastructure support to establish a Gastrointestinal Biopsychosocial (mind-body) Research Center. The investigators have a longstanding record of NIH-funded research on the pathophysiology and treatment of functional GI disorders including irritable bowel syndrome, fecal incontinence, and pelvic floor dyssynergia. These are prevalent disorders-- 15% for irritable bowel, 2-7% for fecal incontinence, and approximately 2% for pelvic floor dyssynergia--that greatly impair quality of life and result in aggregate health care costs exceeding $25 billion annually. Center research themes on the pathophysiology of irritable bowel include the role of visceral pain perception and its modulation by cognitive and psychological processes, neuroimaging studies of central nervous system mechanisms modulating visceral pain, effects of reproductive hormones on irritable bowel symptoms, the role of stress, abuse history, and other psychosocial factors on clinical outcomes, intergenerational transmission of irritable bowel through heredity and social learning, and excess comorbidity of irritable bowel with other somatic disorders. Clinical trial research includes evaluation of cognitive behavior therapy, hypnosis, antidepressants, and patient education for irritable bowel, and biofeedback for fecal incontinence and constipation. Support is requested for the following cores: (1) Administrative core. (2) Research core consisting of study coordinators and full-time recruiter. (3) Research network of institutions that carry out multicenter studies jointly with the investigators (Mayo Clinic, University of Washington, University of Toronto). (4) Data technology core that provides scannable paper and internet-administered questionnaires, automated telephone systems for data acquisition, and intemet software for tracking enrollment and managing rnulticenter studies. (5) Biometry core providing biostatistical support and data management. (6) Seed grant core providing funding for 4 pilot projects by young investigators annually. (7) Education/ dissemination core to disseminate research findings through a Center newsletter and website. We also request support to recruit a new faculty member with expertise in post-infectious irritable bowel. The proposed Center is university wide and includes investigators from psychology, psychiatry, surgery (gynecology division), neuroradiology, dentistry, and the school of public health. ? ?
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