Physiologic effect of abdominal myofascial release (MFR) in irritable bowel syndrome with constipation (IBS-C)

About This Grant

SUMMARY Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction with a childhood prevalence of up to 5.1% in the United States, and up to 22.6% worldwide. Children with IBS experience debilitating psychosocial and gastrointestinal (GI) symptoms resulting in impaired quality of life (QoL). IBS with constipation (IBS-C) is a subtype characterized by abdominal pain, distension or bloating, straining, and infrequent hard stools. While this is a pervasive issue, little is known about the underlying pathophysiology of IBS-C; it is thought to relate to both bowel dysmotility as well as vagal tone dysfunction. Current treatments for IBS-C are limited and often incompletely relieve pain. Integrative health therapies have become new therapeutic avenues in the management of IBS. Myofascial release (MFR) is a form of hands-on physical therapy that targets the myofascial interspaces to increase abdominal wall tissue motility. MFR used during osteopathic manipulations improves abdominal distention, constipation, and QoL in adults with IBS and increases gastric myoelectrical activity in healthy adults as measured by electrogastrography. However, the effect of abdominal-MFR on the activity of other bowel regions is unknown. We have developed and evaluated an abdominal-MFR protocol and shown that using abdominal-MFR in adolescents with IBS is feasible and well accepted without adverse events. Preliminary studies show a significant improvement in GI symptoms and QoL up to one month after the abdominal-MFR intervention. However, the physiologic mechanisms by which MFR improves IBS symptoms have not been investigated, there is a lack of objective methods to assess these physiologic outcomes, and there are no randomized clinical trials assessing MFR's effectiveness in children. MFR therapies could offer a low risk, high- benefit treatment that can be incorporated into current treatment regimens but are understudied in IBS. Our overall objective is to evaluate the physiologic effect of abdominal MFR that results in symptom improvement in children with IBS-C using a randomized comparative trial design. In Aim 1 we will assess the effect of abdominal- MFR versus light-touch-massage on vagal tone (assessed using heart rate variability) and correlate with GI and psychosocial symptoms. We hypothesize that abdominal-MFR improves both GI and psychosocial IBS- associated symptoms by eliciting an improvement in vagal tone. In Aim 2 we will evaluate the effect of abdominal- MFR versus light-touch-massage on myoelectrical activity (gastric, small bowel, and colonic) using a non- invasive abdominal surface wireless motility monitoring system and correlate with symptoms. We hypothesize that abdominal-MFR will induce statistically significant organ specific differences in bowel activity that will correlate with a significant improvement in GI symptoms. Our innovative approach employs established and new non-invasive vagal tone and bowel activity testing strategies. This study will address several knowledge gaps surrounding the mechanisms behind MFR's improvement in IBS-C symptoms with great potential to support non- invasive evidence-based treatments in other IBS subtypes and disorders of gut-brain interaction.