Alimentary TractRegional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention☆
Section snippets
Subjects
Sixteen normal right-handed control subjects (14 women and 2 men; age, 20–52 years; average age, 33 years) and 18 right-handed patients with IBS (16 women and 2 men; age, 24–49 years; average age, 34 years) participated in the study. All volunteers were free of any gastrointestinal complaint. The IBS patients were all seen in the Vanderbilt GI clinic, and met the Rome criteria for IBS, which includes at least 3 months of recurrent abdominal pain and bowel dysfunction.11 Each underwent a basic
Subjective stimulus responses
At 15–mm Hg rectal distention, subjects generally sensed a very-low-intensity stimulation, using the terms “gas,” “barely felt,” or “mild pressure.” At 30–mm Hg rectal distention, both IBS and control subjects expressed nonpainful sensations such as “stool,” “pressure,” or “needed to defecate.” No subject reported pain. At 55–mm Hg rectal distention, all subjects reported painful sensations. Patients with IBS rated this pain significantly higher than control subjects and occurring in an
Discussion
fMRI is a useful technology to measure changes in regional CNS blood oxygenation, which is known to parallel regional metabolic activity.9, 12, 13 We now show that fMRI has adequate sensitivity to measure regional CNS blood flow changes in response to visceral—in this case rectal—stimulation. Activity in the 4 selected CNS pain centers, ACC (BA 24, 32), PFC (BA 10), thalamus, and insular cortex (BA 13–15), promptly increases with nonpainful and painful visceral stimulation. Deactivation occurs
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Address requests for reprints to: Howard R. Mertz, M.D., 1501 TVC, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5340. e-mail: [email protected]; fax: (615) 343-8174.