I have evolved from a long standing interest in urinary tract infections to interstitial cystitis (IC), which from all available evidence is NOT an infectious disease. This is a disease comprising bladder pain, urinary urgency, urinary frequency, and nocturia, 90% of patients are women, and the etiology is unknown.
Funded by the National Institutes of Health, my colleagues and I have four objectives in our investigations of interstitial cystitis:
1) To determine risk factors for IC in a nation-wide case control study seeking exposures antecedent to onset of symptoms.
2) To seek the alleles of susceptibility to IC in a, separate, nation-wide study of families with 2 or more IC patients.
3) To carefully study the onset of IC to reveal hints as to its etiology.
4) To carefully investigate the symptoms of IC to develop a better case definition for this symptom-based disease.
In the process of investigating these aspects of IC, we are attempting to understand its relationship with several non-bladder diseases which appear to be epidemiologically associated with IC: systemic lupus erythematosis, panic attacks, fibromyalgia, irritable bowel syndrome, and inflammatory bowel disease.
Clinical SpecialityI continue to be excited about the variety of infectious diseases patients encountered at University Hospital and attend, on an inpatient basis, two to three months a year.
Trifillis, A.L., Cui, X., Jacobs, S., Warren, J.W. Culture of bladder epithelium from cystoscopic biopsies of patients with interstitial cystitis. J. Urol. 1995; 153:243-248.
Keay, S., Schwalbe, R.S., Trifillis, A.L., Lovchik, J.C., Jacobs, S., Warren, J.W. A prospective study of microorganisms in urine and bladder biopsies from interstitial cystitis patients and controls. Urology 1995; 45:223-229.
Johnson, D.E., Lockatell, C.V., Russell, R.G., Hebel, J.R., Island, M.D., Stapleton, A., Stamm, W.E., Warren, J.W. Comparison of Escherichia coli strains recovered from human cystitis and pyelonephritis infections in transurethrally challenged mice. Infect. Immun. 1998; 66:3059-3065.
Warren, J.W., Abrutyn, E., Hebel, J.R., Johnson, J.R., Schaeffer, A.J., Stamm, W.E. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Clin. Infect. Dis. 1999; 29:745-758.
Warren, J.W., Horne, L.M., Hebel, J.R., Marvel, R.P., Keay, S.K., Chai, T.C. Pilot study of sequential oral antibiotics in the treatment of interstitial cystitis. J. Urol. 2000; 163:1685-1688.
Warren, J.W., Keay, S.K., Meyers, D., Xu, J. Concordance of interstitial cystitis in monozygotic and dizygotic twin pairs. Urology 2001; 57:22-25.
Warren, J.W., Jackson T.L., Langenberg, P., Meyers, D.J., and Xu, J. Prevalence of interstitial cystitis in first-degree relatives of patients with interstitial cystitis. J Urol 2004; 63 (1): 17-21.
Warren, J.W., Diggs, C., Brown, V., Meyer, W.A., Markowitz, S., and Greenberg, P. Dysuria on onset of interstitial cystitis/painful bladder syndrome in women. Urology. (accepted for publication).