Central and Peripheral Effects of Cognitive Behavioral Therapy on Brain-Gut Axis Signaling in Gastroparetic Patients

Eligibility Criteria

• 1. Male and female patients aged 18 - 65 years old (inclusive)
• 2. Symptoms of gastroparesis of at least 12 weeks duration (do not have to be continuous) with varying degrees of nausea, vomiting, early satiety, and/or post-prandial fullness
• 3. An idiopathic etiology
• 4. GES of solids using 4 hours Egg Beaters® protocol within the last 2 years with either:
• 5. Body mass index (BMI) ≥ 17.5 kg/m2
• 6. Have not previously received CBT for coping with chronic illness
• 7. Have access to a computer with internet access
• 8. Speak, write, and understand English
• 9. On stable doses of any medication for 30 days prior to entering the study (exceptions are psychotropic, opioids, and/or illicit drugs) and agrees not to change medications or dosages during the study period.
• 1. Inability to comply with or complete GES test (including allergy to eggs)
• 2. Use of narcotic analgesics greater than three days per week
• 3. Presence of other conditions that could explain the patient's symptoms:
• * Pyloric or intestinal obstruction as determined by endoscopy, upper GI series or abdominal CT scan
• * Active inflammatory bowel disease
• * Known eosinophilic gastroenteritis or eosinophilic esophagitis
• * Primary neurological conditions that could cause nausea and/or vomiting such as increased intracranial pressure, space occupying or inflammatory/infectious lesions
• * Acute liver failure
• * Acute renal failure
• * Chronic renal failure (serum creatinine \>3 mg/dL) and/or on hemodialysis or peritoneal dialysis
• * Prior gastric surgery to restore function or relieve GI symptoms including total or subtotal (near complete) gastric resection, esophagectomy, gastrojejunostomy, or gastric bypass, gastric sleeve, pyloroplasty, pyloromyotomy. Note: patients with prior (Nissen, Dor, or Toupet) fundoplication will be eligible for enrollment.
• * Subject has current evidence of duodenal ulcer, gastric ulcer, diverticulitis, active GERD or infectious gastroenteritis.
• * Any acute gastrointestinal process.
• * Any other plausible structural or metabolic cause
• * Any condition, which in the opinion of the investigator, would interfere with study requirements
• 4. Inability to provide informed consent
• 5. BMI more than 32 and/or weight \> 235 lbs. (limits of the MRI table)
• 6. Enteral or parenteral feeding
• 7. Epilepsy or a prior history of seizures
• 8. Pregnancy or nursing
• 9. Psychotherapy initiated in the last 8 weeks
• 10. Contraindications for MRI: High magnetic fields may pose a serious health hazard to subjects with implanted ferromagnetic objects. Every subject in this study will be carefully screened before entering the high magnetic field shielded room to collect a precise outline of the subject's medical history. Subjects with the following characteristics/disease will not be eligible to participate in the study:
• * History of Head Trauma
• * Any metallic implants (e.g. braces or permanent retainers)
• * Tattoos with metallic ink above the nipple line
• * Surgical Aneurysm Clips
• * Cardiac Pacemaker
• * Prosthetic Heart Valve
• * Neurostimulator
• * Implanted pumps
• * Cochlear Implants
• * Metal rods, Plates
• * Screws
• * Recent Previous Surgery
• * IUD
• * Hearing Aid
• * Dentures (which might create NMR artifacts)
• * Metal Injury to eyes
• * Pregnancy or plans to become pregnant
• * Breast Feeding
• * Meniere's Disease
• * Transdermal (skin) patches such as NicoDerm (nicotine for tobacco dependence), Transderm Scop, or Ortho Evra (birth control)
• * Claustrophobia
• * Suicidal ideation as indicated from the HADS