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Cerebral Activation in Patients With Irritable Bowel Syndrome and Control Subjects During Rectosigmoid Stimulation

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.

View larger version (32K): [in a new window]   Fig. 1. Experimental procedure. Ant = anticipation; 45 = 45-mm Hg rectal balloon distension; sigmoid stimulation = repeated 30-second, 60-mm Hg inflations of sigmoid balloon. Horizontal axis and width of bars are drawn to represent relative times involved (eg, 1-minute rectal stimuli followed by 10 minutes of rest before next trial). Balloon insertion and 30-minute rest period before first scan is not shown.

View larger version (113K): [in a new window]   Fig. 2. Selected axial slices derived from the comparisons of each stimulus condition with the initial resting baseline scan. (Left) These four slices are from the within-subject comparisons and indicate areas of significant activation for each group separately (control, yellow scale; IBS, pink scale). (Right) These three slices are from the between-groups comparisons and indicate areas of greater activation over baseline for one group vs. the other (control > IBS, yellow scale; IBS > control, pink scale). Each row present results from a specific stimulus condition. The activations are displayed as statistical parametric maps that show areas of rCBF increase with a t value coded according to the color bars shown. The Statistical Parametric Mapping (SPM) is superimposed on a standard average anatomical reference image from the Montreal Neurological Institute (the "MNI brain"). The number above each axial slice is the relative distance to the AC-PC line (joining the anterior and posterior commissures), situated at 0 mm. The anterior part of the brain corresponds to the top of the image, and the posterior part corresponds to the bottom. The left side of each image is the right side of the brain (radiological orientation). Ant = anticipation; Sig = sigmoid stimulation.

View larger version (78K): [in a new window]   Fig. 3. Summary of control (yellow scale) and IBS (pink scale) responses along the medial surface of the anterior cingulate cortex for the comparison of stimulation and anticipation with the baseline before and after conditioning. Two slices are shown from the left and right hemisphere to a depth of 2 mm (top) and 6 mm (bottom).

View larger version (61K): [in a new window]   Fig. 4. Absolute rCBF differences between control subjects and IBS patients at baseline.