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Brain Responses to Visceral Stimuli Reflect Visceral Sensitivity Thresholds in Patients With Irritable Bowel Syndrome
Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Gastroenterologi och hepatologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Endokrin- och magtarmmedicinska kliniken US.
UCLA, Los Angeles, USA.
Barrow Neurological Institute, Phoenix, Arizona.
Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk radiologi. Linköpings universitet, Hälsouniversitetet.ORCID-id: 0000-0002-2167-2450
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2012 (Engelska)Ingår i: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 142, nr 3, s. 463-472Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND & AIMS:

Only a fraction of patients with irritable bowel syndrome (IBS) have increased perceptual sensitivity to rectal distension, indicating differences in processing and/or modulation of visceral afferent signals. We investigated the brain mechanisms of these perceptual differences.

METHODS:

We analyzed data from 44 women with IBS and 20 female healthy subjects (controls). IBS symptom severity was determined by a severity scoring system. Anxiety and depression symptoms were assessed using the hospital anxiety and depression score. Blood oxygen level-dependent signals were measured by functional magnetic resonance imaging during expectation and delivery of high (45 mmHg) and low (15 mmHg) intensity rectal distensions. Perception thresholds to rectal distension were determined in the scanner. Brain imaging data were compared among 18 normosensitive and 15 hypersensitive patients with IBS and 18 controls. Results were reported significant if peak P-values were ≤.05, with family-wise error correction in regions of interest.

RESULTS:

The subgroups of patients with IBS were similar in age, symptom duration, psychological symptoms, and IBS symptom severity. Although brain responses to distension were similar between normosensitive patients and controls, hypersensitive patients with IBS had greater activation of insula and reduced deactivation in pregenual anterior cingulate cortex during noxious rectal distensions, compared to controls and normosensitive patients with IBS. During expectation of rectal distension, normosensitive patients with IBS had more activation in right hippocampus than controls.

CONCLUSIONS:

Despite similarities in symptoms, hyper- and normosensitive patients with IBS differ in cerebral responses to standardized rectal distensions and their expectation, consistent with differences in ascending visceral afferent input.

Ort, förlag, år, upplaga, sidor
Elsevier, 2012. Vol. 142, nr 3, s. 463-472
Nyckelord [en]
Barostat; Visceral Sensitivity; Functional MRI; Anticipation
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-73455DOI: 10.1053/j.gastro.2011.11.022ISI: 000300774700024OAI: oai:DiVA.org:liu-73455DiVA, id: diva2:472542
Anmärkning

funding agencies|County Council of Ostergotland, Sweden||Lions Forskningsfond for Folksjukdomar||Bengt Ihresfond, Svenska Lakaresallskapet||Magnus Bergvall fond||National Institutes of Health| DK 64531 DK 48351 K23 DK73451 |

Tillgänglig från: 2012-01-04 Skapad: 2012-01-04 Senast uppdaterad: 2017-12-08Bibliografiskt granskad
Ingår i avhandling
1. Irritable Bowel Syndrome: Studies of central pathophysiological mechanisms and effects of treatment
Öppna denna publikation i ny flik eller fönster >>Irritable Bowel Syndrome: Studies of central pathophysiological mechanisms and effects of treatment
2015 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background and aims

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain and altered bowel habits. The societal costs of the disorder are significant, as are its negative effects on quality of life. Medical treatment options are limited, but psychological treatments such as hypnotherapy have proven to be effective. Important pathophysiological mechanisms include disturbances in brain processing of visceral sensation and expectation of visceral sensation. Increased sensation of stimuli (hypersensitivity) is present in a subset of IBS patients to distensions in the lower part of the gastrointestinal tract, indicating a probable important pathophysiological mechanism in IBS. The overall aim of the thesis was to further study the central pathophysiological mechanisms involved in IBS. Specifically, we aimed to identify differences in brain response to standardized repeated rectal distensions and expectation of these stimuli between IBS patients (with or without perceptual rectal hypersensitivity), and healthy controls. Furthermore, we aimed to investigate IBS patients´ brain responses to standardized rectal distensions and expectation of these stimuli after either a successful course hypnotherapy or educational intervention.

Methods

Functional magnetic resonance imaging (fMRI) data were acquired and analyzed from 15 IBS patients with visceral hypersensitivity, and 18 IBS patients with normal visceral sensitivity (papers I and II). In paper III, fMRI data were analyzed from IBS patients who reported significant symptom reduction after either a course of hypnotherapy, or an educational intervention. FMRI data from IBS patients and healthy controls were also compared.

Results

The findings reported in papers I and II suggest, that the differences in brain response between IBS patients with and without rectal hypersensitivity, can be explained by changes in brain response during the course of the experiment. Even though the brain responses were similar between groups during the early phase of the experiment, they became substantially different during the late phase. The IBS patients with rectal hypersensitivity demonstrated increased brain response in several brain regions and networks involved in visceral sensation and processing. In contrast, IBS patients with normal rectal sensitivity exhibited reduced brain response during the late phase of the experiment. As reported in paper III, similar symptom reduction was achieved for both treatments. The symptomatic improvement was associated with a reduction of response in the anterior insula, indicating an attenuated awareness of the stimuli. The hypnotherapy group had a reduction of response in the posterior insula, indicating less input to the brain, possibly due to changed activity in endogenous pain modulatory systems. In patients who reported significant symptom reduction following treatment, the brain response to rectal distension got more similar to that observed in healthy controls.

Conclusions

The results from papers I and II indicate that a subpopulation of IBS patients lacks the ability to habituate to repeated rectal distensions and expectation of these stimuli. Results from paper III indicate that the abnormal processing of visceral stimuli in IBS can be altered, and that the treatments probably had a normalizing effect on the central processing abnormality of visceral signals in IBS.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2015. s. 62
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1472
Nationell ämneskategori
Neurologi Radiologi och bildbehandling Gastroenterologi
Identifikatorer
urn:nbn:se:liu:diva-122144 (URN)10.3384/diss.diva-122144 (DOI)978-91-7685-983-4 (ISBN)
Disputation
2015-11-06, Berzeliussalen, Campus US, Linköping, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2015-10-20 Skapad: 2015-10-20 Senast uppdaterad: 2019-11-15Bibliografiskt granskad

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Larsson, MatsEngström, MariaLundberg, PeterStröm, MagnusWalter, Susanna

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Larsson, MatsEngström, MariaLundberg, PeterStröm, MagnusWalter, Susanna
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Centrum för medicinsk bildvetenskap och visualisering, CMIVGastroenterologi och hepatologiHälsouniversitetetEndokrin- och magtarmmedicinska kliniken USMedicinsk radiologiMedicinsk radiofysikRadiofysikavdelningen USRöntgenkliniken i Linköping
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