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NEUROREGULATION AND MOTILITY

Absence of increasing cortical fMRI activity volume in response to increasing visceral stimulation in IBS patients

Division of Gastroenterology and Hepatology and the Digestive Disease Center, The Medical College of Wisconsin, Milwaukee, Wisconsin 53226

Submitted 20 November 2003 ; accepted in final form 26 March 2004

Cerebral cortical activity associated with perceived visceral sensation represents registration of afferent transduction and cognitive processes related to perception. Abnormalities of gut sensory function can involve either or both of these processes. Cortical registration of subliminal viscerosensory signals represents cerebral cortical activity induced by stimulation of intestinal sensory neurocircuitry without the influence of perception-related cortical activity, whereas those associated with perception represent both neural circuitry and cognitive processes. Our aims were to determine and compare quantitatively cerebral cortical functional magnetic resonance imaging (fMRI) activity in response to subliminal, liminal, and nonpainful supraliminal rectal distension between a group of irritable bowel syndrome (IBS) patients and age/gender-matched controls. Eight female IBS patients and eight age-matched healthy female control subjects were studied using brain fMRI techniques. Three barostat-controlled distension levels were tested: 1) 10 mmHg below perception (subliminal), 2) at perception (liminal), and 3) 10 mmHg above perception (supraliminal). In control subjects, there was a direct relationship between stimulus intensity and cortical activity volumes, ie., the volume of fMRI cortical activity in response to subliminal (3,226 ± 335 µl), liminal (5,751 ± 396 µl), and supraliminal nonpainful stimulation (8,246 ± 624 µl) were significantly different (P < 0.05). In contrast, in IBS patients this relationship was absent and fMRI activity volumes for subliminal (2,985 ± 332 µl), liminal (2,457 ± 342 µl), and supraliminal nonpainful stimulation (2,493 ± 351 µl) were similar. Additional recruitment of cortical fMRI activity volume in response to increasing stimulation from subliminal to liminal and supraliminal domains is absent in IBS patients, suggesting a difference in the processing of perceived stimulation compared with controls.

subliminal; perception; functional magnetic resonance imagery; rectal distension; viscerosensation

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