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Brain Responses to Visceral Stimuli Reflect Visceral Sensitivity Thresholds in Patients With Irritable Bowel Syndrome
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology and Gastroenterology UHL.
UCLA, Los Angeles, USA.
Barrow Neurological Institute, Phoenix, Arizona.
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-2167-2450
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2012 (English)In: Gastroenterology, ISSN 0016-5085, Vol. 142, no 3, 463-472 p.Article in journal (Refereed) Published
Abstract [en]


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.


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.


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.


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.

Place, publisher, year, edition, pages
Elsevier, 2012. Vol. 142, no 3, 463-472 p.
Keyword [en]
Barostat; Visceral Sensitivity; Functional MRI; Anticipation
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-73455DOI: 10.1053/j.gastro.2011.11.022ISI: 000300774700024OAI: diva2:472542

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 |

Available from: 2012-01-04 Created: 2012-01-04 Last updated: 2015-10-20Bibliographically approved
In thesis
1. Irritable Bowel Syndrome: Studies of central pathophysiological mechanisms and effects of treatment
Open this publication in new window or tab >>Irritable Bowel Syndrome: Studies of central pathophysiological mechanisms and effects of treatment
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
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.


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.


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.


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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 62 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1472
National Category
Neurology Radiology, Nuclear Medicine and Medical Imaging Gastroenterology and Hepatology
urn:nbn:se:liu:diva-122144 (URN)10.3384/diss.diva-122144 (DOI)978-91-7685-983-4 (print) (ISBN)
Public defence
2015-11-06, Berzeliussalen, Campus US, Linköping, 13:00 (English)
Available from: 2015-10-20 Created: 2015-10-20 Last updated: 2015-10-20Bibliographically approved

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Larsson, MatsEngström, MariaLundberg, PeterStröm, MagnusWalter, Susanna
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Center for Medical Image Science and Visualization (CMIV)Gastroenterology and HepatologyFaculty of Health SciencesDepartment of Endocrinology and Gastroenterology UHLRadiologyRadiation PhysicsDepartment of Radiation PhysicsDepartment of Radiology in Linköping
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