Brain-Gut Interactions in Overweight and Normal Weight Patients With Chronic Abdominal Pain
Brain-Gut Interactions in Overweight and Normal Weight Patients With Chronic Abdominal Pain
About 15 to 20 percent of individuals living in the United States have chronic abdominal
 pain, often of unknown origin, which is often difficult to diagnose and treat. One possible
 cause of chronic abdominal pain is an inflammation of the intestines, but it is not known
 whether the two are related. Furthermore, although overweight people tend to be more likely
 to have increased inflammation, it is not known whether there is a connection between
 increased body weight and chronic abdominal pain. This study will examine the relationship
 between symptoms of chronic abdominal pain and intestinal inflammation by comparing the
 medical test results of normal weight and overweight patients who have a history of chronic
 abdominal pain.

 This study will include 224 subjects, who must be men and women between the ages of 13 and
 45. Half the subjects will be healthy participants, and half will have had chronic abdominal
 pain of unknown origin for longer than 6 months. Female participants must take a urine
 pregnancy test before starting the study, and will not be allowed to participate if the test
 is positive. During the study, patients will visit the NIH Clinical Center on two occasions
 for testing.

 On the first visit, patients will provide a medical history, including information about
 current medications or natural remedies and tobacco and alcohol use, and will also fill out
 questionnaires to provide information about symptoms, current levels of gastrointestinal
 pain, and general quality of life. The study researchers will conduct a physical examination,
 measure patients height and weight, and draw blood for testing.

 Patients will be asked to not eat or drink anything for 8 hours before the second visit, and
 will be asked to bring a bathing suit and a swim cap to the Clinical Center. On the day of
 the visit, patients will fill out questionnaires to provide information about symptoms,
 current levels of gastrointestinal pain, and general quality of life. Patients will also
 provide a blood sample for testing. Researchers will measure patients blood pressure and
 heart rate, height, weight, waist/hip circumference, and intra-abdominal measurement.
 Patients will also be asked to put on the bathing suit and swim cap to have their body fat
 measured using a machine called the BOD POD. To test the gastrointestinal system, patients
 will then be asked to drink a sugar-based test solution, and researchers will collect all
 voided urine for the next 5 to 6 hours. (Patients may drink water during this time.)

 On either Day 1 or Day 2 of the study, patients will sip, swish and spit an additional sweet
 taste solution. Patients will sip, swish, and spit different concentrations of this sweet
 taste solution, for a total of 25 tastings of this solution. Subjects will then complete
 questionnaires about their sweetness preferences related to these 25 tastings.
The objective of this natural history study is to assess the specific gastrointestinal (GI)
 symptoms and pathophysiology of chronic abdominal pain of unknown origin at the molecular
 level. This research will test the hypothesis that chronic abdominal pain of unknown etiology
 has an inflammatory mechanism. Although increased body weight may be associated with
 increased inflammation, it is unclear that increased body weight is associated with chronic
 abdominal pain. Accordingly both overweight and normal weight subjects with and without
 chronic abdominal pain of unknown origin will be included in this study. The study design is
 a longitudinal natural history.

 The purpose is to test the relationship between abdominal pain symptoms and intestinal
 inflammation in two groups (overweight and normal weight patients with chronic abdominal pain
 of unknown origin). After obtaining informed consent, an initial screening history and
 physical exam to ensure eligibility will be performed. The participants abdominal pain,
 psychological distress, quality of life, socio-demographic, and co-morbidities will be
 assessed via questionnaires. Anthropometry, vital signs, and fasting blood work will be drawn
 at both of the two visits to the Clinical Center of the National Institutes of Health for
 clinical screening labs and research purposes.

 There are three measures of intestinal inflammation including fecal calprotectin, intestinal
 permeability, and serum cytokine IL-6 levels. A stool sample will be collected to measure
 fecal calprotectin. Intestinal permeability will be measured with the administration of a
 sugar based test solution which will be given orally to participants after an overnight fast
 on their second visit. Excreted urine sugar ratios, expressed per m2 of body surface area,
 will measure gastrointestinal permeability. Body mass and body fat analysis
 (plethysmography), intra-abdominal and liver ultrasound, and Fibroscan measures will also be
 collected on visit two. On either Day 1 or Day 2 of the study, patients will sip, swish and
 spit additional sweet taste solutions and complete questionnaires about their sweetness
 preferences related to these tastings.
-  INCLUSION CRITERIA:

 To be included, patients must meet all of the following:

 -  Have a history of abdominal pain for greater than 6 months

 -  Males ages 13-45 years old or females ages 13-45 years old who have had their menses
 for at least 2 years

 -  Provide written informed consent, prior to entering the study or undergoing any study
 procedures

 EXCLUSION CRITERIA:

 Patients with any of the following will be excluded:

 -  Have a history of an organic GI disease (e.g., inflammatory bowel disease, celiac
 disease, biliary disorders, bowel resection) cardiac, pulmonary, neurologic, renal,
 endocrine, or gynecological pathology

 -  Are currently taking medications for GI symptoms daily such as 5-HT3 antagonists/5-HT4
 agonists, prokinetic drugs, laxatives (but not fiber supplements), anti-diarrheals or
 antispasmodics

 -  Are currently taking other medications daily that would alter serotonin (e.g.,
 serotonin specific reuptake inhibitors [SSRI]), catecholamines (e.g., tricycle
 antidepressants but not inhaled beta-agonist for mild-moderate asthma), cortisol
 (excluding inhaled corticosteroids)

 -  Work during the late evening and night (as cortisol levels may be altered)

 -  Severe co-morbid pain or psychiatric conditions (e.g., fibromyalgia, bipolar or
 psychotic disorder)

 -  Take greater than 300 mg of caffeine containing beverages or food (e.g. chocolate) in
 the afternoon-evening or greater than 2 servings of alcohol containing beverages
 everyday (decaffeinated coffee is acceptable)

 -  Are unable to give informed consent

 -  Are unable to physically use the touch screen for the purpose of the study

 -  Are visually impaired or currently institutionalized

 -  Females who are pregnant or lactating

 -  NINR employees, subordinates/relatives/ or co-workers

 -  Any NIH employee who is a subordinate/relative/or co-worker of a study investigator