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Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
University of Calif Los Angeles, CA USA .
Karolinska Institute, Sweden .
University of Calif Los Angeles, CA USA .
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2013 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 37, no 12, 1184-1197 p.Article in journal (Refereed) Published
Abstract [en]

Background Gut-directed hypnotherapy can reduce IBS symptoms, but the mechanisms underlying this therapeutic effect remain unknown. Aim To determine the effect of hypnotherapy and educational intervention on brain responses to cued rectal distensions in IBS patients. Methods Forty-four women with moderate-to-severe IBS and 20 healthy controls (HCs) were included. Blood oxygen level dependent (BOLD) signals were measured by functional Magnetic Resonance Imaging (fMRI) during expectation and delivery of high- (45mmHg) and low-intensity (15mmHg) rectal distensions. Twenty-five patients were assigned to hypnotherapy (HYP) and 16 to educational intervention (EDU). Thirty-one patients completed treatments and posttreatment fMRI. Results Similar symptom reduction was achieved in both groups. Clinically successful treatment (all responders) was associated with significant BOLD attenuation during high-intensity distension in the dorsal and ventral anterior insula (cluster size 142, P=0.006, and cluster size 101, P=0.005 respectively). Moreover HYP responders demonstrated a prepost treatment BOLD attenuation in posterior insula (cluster sizes 59, P=0.05) while EDU responders had a BOLD attenuation in prefrontal cortex (cluster size 60, P=0.05). Prepost differences for expectation conditions were almost exclusively seen in the HYP group. Following treatment, the brain response to distension was similar to that observed in HCs, suggesting that the treatment had a normalising effect on the central processing abnormality of visceral signals in IBS. Conclusions The abnormal processing and enhanced perception of visceral stimuli in IBS can be normalised by psychological interventions. Symptom improvement in the treatment groups may be mediated by different brain mechanisms. Clinical trial number: NCT01815164.

Place, publisher, year, edition, pages
Wiley-Blackwell , 2013. Vol. 37, no 12, 1184-1197 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-94599DOI: 10.1111/apt.12319ISI: 000319295100006OAI: oai:DiVA.org:liu-94599DiVA: diva2:633617
Note

Funding Agencies|County Council of Ostergotland||Lions forskningsfond for folksjukdomar||Svenska Lakaresallskapets forskningsfond||NIDDK|DK048351|

Available from: 2013-06-27 Created: 2013-06-27 Last updated: 2017-12-06
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.

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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 62 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1472
National Category
Neurology Radiology, Nuclear Medicine and Medical Imaging Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-122144 (URN)10.3384/diss.diva-122144 (DOI)978-91-7685-983-4 (ISBN)
Public defence
2015-11-06, Berzeliussalen, Campus US, Linköping, 13:00 (English)
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Available from: 2015-10-20 Created: 2015-10-20 Last updated: 2016-04-24Bibliographically approved

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Lundberg, PeterStröm, MagnusEngström, MariaWalter, Susanna

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Department of Clinical and Experimental MedicineFaculty of Health SciencesCenter for Medical Image Science and Visualization (CMIV)Division of Radiological SciencesDepartment of Radiation PhysicsDepartment of Radiology in LinköpingGastroenterology and HepatologyDepartment of GastroentorologyRadiology
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