title: Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome.
abstract: OBJECTIVE
  The association of psychosocial disturbances with more severe irritable bowel syndrome (IBS) is well recognized. However, there is no evidence as to how these associations might be mediated. Functional magnetic resonance imaging (fMRI) offers an opportunity to study whether activation of the cingulate cortex, an area involved with the affective and pain intensity coding might be linked to poorer clinical status with IBS. In this case report, we found an association between the severity of a patient's clinical symptoms and psychosocial state, with activation of the cingulate cortex. We also found that clinical and psychosocial improvement was associated with reduced cingulate activation.
  
  
  METHODS
  Observational case report of a young woman observed for 16 years with a history of sexual abuse, psychosocial distress, and functional GI complaints. Psychosocial, clinical, and fMRI assessment was performed when the patient experienced severe symptoms and again 8 months later when clinically improved.
  
  
  RESULTS
  During severe illness, the patient had major psychosocial impairment, high life stress, a low visceral pain threshold, and activation of the midcingulate cortex (MCC), prefrontal area 6/44, and the somatosensory cortex, areas associated with pain intensity encoding. When clinically improved, there was resolution in activation of these 3 areas, and this was associated with psychosocial improvement and an increased threshold to rectal distention.
  
  
  CONCLUSIONS
  Activation of the MCC and related areas involved with visceral pain encoding are associated with poor clinical status in patients with severe IBS and psychosocial distress and appear to be responsive to clinical improvement.
authors.affiliation: UNC Center for Functional GI and Motility Disorders, Division of Digestive Diseases and Department of Radiology and Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina 27599, USA. Drossman@med.unc.edu
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Drossman
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Ringel
authors.forename: Brent A
authors.initials: BA
authors.lastname: Vogt
authors.forename: Jane
authors.initials: J
authors.lastname: Leserman
authors.forename: Weili
authors.initials: W
authors.lastname: Lin
authors.forename: J Keith
authors.initials: JK
authors.lastname: Smith
authors.forename: William
authors.initials: W
authors.lastname: Whitehead
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D001921:Brain / Q000503:physiopathology*; D002648:Child; D003109:Colonic Diseases, Functional / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000175:diagnosis / Q000503:physiopathology