Mapping of Brain Activations to Rectal Balloon Distension Stimuli in Male Patients with Irritable Bowel Syndrome Using Functional Magnetic Resonance Imaging

Guleria, Anupam; Karyampudi, Arun; Singh, Rajan; Khetrapal, C. L.; Verma, Amrisha; Ghoshal, Uday C; Kumar, Deepak

doi:10.5056/jnm16148

Cited by 49 publications

(34 citation statements)

References 66 publications

(98 reference statements)

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“…109 Cerebral and emotional response to pain is well known to differ among males and females. A recent Indian study on male IBS subjects and healthy controls showed differential brain response to rectal balloon distension and among patients with IBS-C and IBS-D. 110 Statement 16: Psychosocial factors have significant role in the development and aggravation of IBS symptoms.…”

Section: Team 2: Pathophysiologymentioning

confidence: 99%

Second Asian Consensus on Irritable Bowel Syndrome

Gwee

Gonlachanvit

Ghoshal

et al. 2019

J Neurogastroenterol Motil

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Background/Aims There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. Methods Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. Results Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. Conclusions Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.

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Section: Team 2: Pathophysiologymentioning

confidence: 99%

Second Asian Consensus on Irritable Bowel Syndrome

Gwee

Gonlachanvit

Ghoshal

et al. 2019

J Neurogastroenterol Motil

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“…Many other cortical areas are activated during bladder filling, such as peri‐acqueductal gray matter, insula, and frontal lid as well as parietal and cerebellar lobes. These cortical projections could also constitute a site of sensory interactions between the bladder and the rectum 19‐21 …”

Section: Discussionmentioning

confidence: 99%

Relationship between desire to void and bladder capacity and rectal sensory function in patients with multiple sclerosis and anorectal disorders

Pouyau

Grasland

Leroux

et al. 2020

Neurourology and Urodynamics

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Aims:The primary aim of this study was to assess the relationship between a strong desire to void (SDV) and rectal sensory function in patients with multiple sclerosis (PwMS) and anorectal disorders. The secondary aim was to identify clinical, urodynamic or manometric factors associated with greater rectal sensory function impairment in this population.Methods: Thirty PwMS (mean age 49.2 ± 10.9 years) with anorectal disorders (constipation and/or fecal incontinence) participated in this observational study. Rectal sensory parameters during anorectal manometry were recorded at a strong desire to void and after urination (PV, post-void). The primary outcome was the desire to defecate volume. Secondary outcomes were first perception and maximum tolerated threshold volumes, presence and modulation of recto-anal inhibitory reflex. Results: The mean desire to defecate volume was 125 ± 59 mL at SDV and 104 ± 64 mL at PV (P < .001). The mean maximum tolerated volume was 167 ± 61 mL at SDV vs 141 ± 64 mL after urination (P = .01). The other parameters were not different between SVD and PV conditions. No predictive factors for greater impairment of rectal sensory function were identified. Conclusion: This study suggests a relationship between bladder sensation and thus bladder capacity, and rectal sensory function in PwMS and with anorectal disorders. K E Y W O R D S multiple sclerosis, neurogenic, rectal diseases, rectal sensation, sensation, urinary bladder Abbreviations: ARD, anorectal disorders; EDSS, Expanded Disability Status Scale; LUTS, lower urinary tract symptoms; MS, multiple sclerosis; NBD, neurogenic bowel dysfunction; OAB, overactive bladder; PwMS, patients with multiple sclerosis; PV, post void; RAIR, recto-anal inhibitory reflex; SDV, strong desire to void; SUI, stress urinary incontinence; USP, urinary symptom profile score.|

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“…The amygdala is functionally closely connected to brain areas that generate and integrate autonomic arousal states and contributes to integrating emotional processing of rectal signals when being aware of the stimuli . Previous functional neuroimaging studies of anorectal distention described activations of limbic areas, such as the insula, cingulate gyrus, hippocampus, and amygdala in healthy individuals . On the other hand, deactivation of limbic areas was a finding in several functional imaging studies examining defecation and different forms of fecal incontinence .…”

Section: Discussionmentioning

confidence: 99%

“…18 Previous functional neuroimaging studies of anorectal distention described activations of limbic areas, such as the insula, cingulate gyrus, hippocampus, and amygdala in healthy individuals. 15,17,22,37 On the other hand, deactivation of limbic areas was a finding in several functional imaging studies examining defecation and different forms of fecal incontinence. 16,18 Based on these findings, we conclude that multiple sclerosis lesions in the parahippocampal area and amygdala may alter the efferent autonomic output in response to rectal sensory signals with hyper-reflexic colonic motor dysfunction as a possible cause of bowel incontinence.…”

Section: Lesioned Areas Associated With Bowel Incontinencementioning

confidence: 99%

Brain MRI Lesions are Related to Bowel Incontinence in Multiple Sclerosis

Fröhlich

Linker

Engelhorn

et al. 2018

Journal of Neuroimaging

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BACKGROUND AND PURPOSE Bowel incontinence in multiple sclerosis might be associated with specific lesion sites. This study intended to determine associations between bowel incontinence and cerebral multiple sclerosis lesions using a voxel‐wise lesion symptom mapping analysis. METHODS We conducted a retrospective study of multiple sclerosis patients with self‐reported bowel incontinence and matched controls. Lesions were manually outlined on T2‐weighted MRI scans and transformed into stereotaxic space. We performed a voxel‐wise subtraction analysis subtracting the lesion overlap of patients without from patients with bowel incontinence. Finally, we compared the absence or presence of bowel incontinence between patients with and without lesions in a given voxel using the Liebermeister test. RESULTS A total of 51 patients were included in the study. The analysis yielded associations between bowel incontinence and lesions in the supramarginal gyrus of the left secondary somatosensory cortex and another lesion cluster in the right parahippocampal gyrus and amygdala. CONCLUSIONS Our analysis indicates associations between bowel incontinence and lesions in the left supramarginal gyral area contributing to integrating anorectal‐visceral sensation and in the right parahippocampal gyrus and amygdala contributing to generating visceral autonomic arousal states. Moreover, our results suggest left hemispheric dominance of sensory visceral integration, while limbic areas of the right hemisphere seem to contribute to the autonomic component of the defecation process. A limitation of our study is the retrospective evaluation of the bowel incontinence status based on medical records. Further research should evaluate the bowel incontinence status in multiple sclerosis patients prospectively to overcome the limitations of the current study.

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Mapping of Brain Activations to Rectal Balloon Distension Stimuli in Male Patients with Irritable Bowel Syndrome Using Functional Magnetic Resonance Imaging

Cited by 49 publications

References 66 publications

Second Asian Consensus on Irritable Bowel Syndrome

Second Asian Consensus on Irritable Bowel Syndrome

Relationship between desire to void and bladder capacity and rectal sensory function in patients with multiple sclerosis and anorectal disorders

Brain MRI Lesions are Related to Bowel Incontinence in Multiple Sclerosis

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