title: Gastric fundic distension activates fronto-limbic structures but not primary somatosensory cortex: a functional magnetic resonance imaging study.
abstract: BACKGROUND
  The brain representation of visceral stimulation bears important similarities to that of somatic stimulation. However, the role of the primary (S1) and secondary (S2) somatosensory cortices in mediating gastric sensation is uncertain.
  
  
  METHODS
  Eighteen healthy, right-handed volunteers (age 32 years+/-6.5 years; 14 men) underwent dynamic assessment of the relationship between sensation and fundic barostat distending pressure and volume, and then brain functional magnetic resonance imaging (fMRI) during noxious fundic distension. Cytoarchitectonic probability maps were used to examine in detail the null hypothesis that fundic distension did not produce significant activation of S1 or S2.
  
  
  RESULTS
  Distending volume explained 74% of the variance in gastric sensation, compared to 64% with distending pressure. Incorporating distending volume into the regressor function for our fMRI analyses, we found that noxious fundic distension activated a widespread network of brain regions, including the pontine brainstem, thalami, cerebellum, insular cortex bilaterally, anterior and posterior cingulate cortex, right frontal lobe, and inferior parietal lobules. In detailed analyses, we found no evidence of activation of S1, but did find activation in one region of S2.
  
  
  CONCLUSIONS
  Our findings suggest that an extensive, predominantly fronto-limbic network of brain regions, including the insular cortex, mediates perception of noxious gastric fundic distension in healthy humans, without significant participation by the primary somatosensory cortex. This and other recent studies lay the groundwork for investigations comparing brain processing of visceral stimuli between healthy volunteers and patients with functional dyspepsia.
authors.affiliation: Division of Gastroenterology, S-357, Box 0538, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143-0538, and The Children's Hospital of Philadelphia, PA 19104, USA. uri.ladabaum@ucsf.edu
authors.forename: Uri
authors.initials: U
authors.lastname: Ladabaum
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Roberts
authors.forename: David J
authors.initials: DJ
authors.lastname: McGonigle
mesh_terms: D000328:Adult; D001921:Brain / Q000502:physiology*; D001931:Brain Mapping; D005260:Female; D005748:Gastric Fundus / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D010812:Physical Stimulation; D011312:Pressure; D012677:Sensation / Q000502:physiology*; D013003:Somatosensory Cortex / Q000502:physiology