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Patients with Irritable Bowel Syndrome have Altered Emotional Modulation of Neural Responses to Visceral Stimuli.

Gastroenterology. 2010 Jun 22;

Authors: Elsenbruch S, Rosenberger C, Bingel U, Forsting M, Schedlowski M, Gizewski ER

BACKGROUND & AIMS:: In patients with irritable bowel syndrome (IBS), pain amplification and hypervigilance might result from altered affective-motivational modulation of the pain response. We investigated the effects of emotional context on the behavioral and neural response to visceral stimuli in IBS patients. METHODS:: We used functional magnetic resonance imaging (fMRI) to assess the blood oxygen level-dependent response to non-painful and painful rectal distensions 15 female IBS patients and 12 healthy women. Distensions were delivered during psychological stress or relaxation; data were compared with those in a neutral condition (control). Group and context-dependent differences in the processing of visceral stimulation were assessed at behavioral and the neuronal levels. Secondary analyses of group differences were performed using anxiety scores as a covariate because of higher anxiety symptoms among patients with IBS. RESULTS:: During rectal stimulation, IBS patients demonstrated more pronounced stress-induced modulation of neural activation in multiple brain regions, including the insula, mid-cingulate cortex, and ventrolateral prefrontal cortex. In response to relaxation, IBS patients demonstrated reduced modulation of distension-induced activation in the insula. During relaxation, the difference observed between groups could be accounted for by higher anxiety symptoms in patients with IBS; differential effects of stress in the insula and prefrontal regions were not attributable to anxiety. CONCLUSIONS:: IBS patients appear to have disrupted emotional modulation of neural responses to visceral stimuli, possibly reflecting the neural basis for altered visceral interoception by stress and negative emotions.

PMID: 20600024 [PubMed - as supplied by publisher]

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