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From the CURE Digestive Diseases Research Center/Neuroenteric Disease Program (B.D.N., S.W.G.D., J.M., S.B., L.C., E.A.M.), Departments of Medicine (S.W.G.D., L.C., E.A.M.) and Physiology (E.A.M.), University of California School of Medicine, Los Angeles, and the Departments of Psychology (B.D.N.) and Nuclear Medicine (M.M.), VA Greater Los Angeles Healthcare System and University of California (M.M.), Irvine, California.
Address reprint requests to: Bruce D. Naliboff, PhD, UCLA/CURE Neuroenteric Disease Program, CURE Digestive Diseases Research Center, VA Greater Los Angeles Healthcare System, West Los Angeles, Building 115, Room 223, 11301 Wilshire Blvd., Los Angeles, CA 90073. Email: naliboff{at}ucla.edu
OBJECTIVE: Patients with irritable bowel syndrome (IBS) show evidence of altered perceptual responses to visceral stimuli, consistent with altered processing of visceral afferent information by the brain. In the current study, brain responses to anticipated and delivered rectal balloon distension were assessed.
METHODS: Changes in regional cerebral blood flow were measured using H215O-water positron emission tomography in 12 nonconstipated IBS patients and 12 healthy control subjects. Regional cerebral blood flow responses to moderate rectal distension (45 mm Hg) and anticipated but undelivered distension were assessed before and after a series of repetitive noxious (60-mm Hg) sigmoid distensions.
RESULTS: Brain regions activated by actual and simulated distensions were similar in both groups. Compared with control subjects, patients with IBS showed lateralized activation of right prefrontal cortex; reduced activation of perigenual cortex, temporal lobe, and brain stem; but enhanced activation of rostral anterior cingulate and posterior cingulate cortices.
CONCLUSIONS: IBS patients show altered brain responses to rectal stimuli, regardless of whether these stimuli are actually delivered or simply anticipated. These alterations are consistent with reported alterations in autonomic and perceptual responses and may be related to altered central noradrenergic modulation.
Key Words: irritable bowel syndrome • limbic system • conditioned fear • antinociception.
Abbreviations: ACC = anterior cingulate cortex; BA = Brodmann’s area; CNS = central nervous system; fMRI = functional magnetic resonance imaging; IBS = irritable bowel syndrome; PAG = periaqueductal gray; PET = positron emission tomography; PFC = prefrontal cortex; PHG = parahippocampal gyrus; rCBF = regional cerebral blood flow.
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