Regional cerebral blood flow during gastric balloon distention in functional dyspepsia.
OBJECTIVE
Hypersensitivity to proximal gastric distention as a result of abnormal central nervous system processing of visceral stimuli is a possible pathophysiologic mechanism in functional dyspepsia (FD). Increasing evidence suggests involvement of both lateral and medial pain systems in normal visceral sensitivity and aberrant brain activation patterns in visceral hypersensitivity. We hypothesized that there is involvement of aberrant brain activation in FD with hypersensitivity to gastric distention. Our aim was to investigate regional cerebral blood flow during painful proximal gastric distention in hypersensitive FD.


METHODS
Brain (15)O-water positron emission tomography was performed in 13 FD patients with symptoms of gastric hypersensitivity during 3 conditions: no distention, sham distention, and isobaric distention to unpleasant or painful sensation. Pain, discomfort, nausea, and bloating during maximal distention were rated on visual analogue scales. Data were analyzed using statistical parametric mapping.


RESULTS
The threshold for painful distention was 6.6 +/- 3.8 mm Hg greater than the minimal distending pressure. At the corrected P level of less than .05, subtraction analysis (painful distention - no distention) showed activations in bilateral gyrus precentralis, bilateral gyrus frontalis inferior, bilateral gyrus frontalis medialis, bilateral gyrus temporalis superior, bilateral cerebellar hemisphere, and left gyrus temporalis inferior. Sham distention minus no distention showed no activations.


CONCLUSIONS
Similar to healthy volunteers, proximal stomach distention in FD activates components of the lateral pain system and bilateral frontal inferior gyri, putatively involved in regulation of hunger and satiety. In hypersensitive FD, these activations occur at significantly lower distention pressures. In contrast to findings in normosensitivity, none of the components of the medial pain system were significantly activated.
Vandenberghe
Joris
J
Department of Psychiatry, Division of Liaison Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
Dupont
Patrick
P
Van Oudenhove
Lukas
L
Bormans
Guy
G
Demyttenaere
Koen
K
Fischler
Benjamin
B
Geeraerts
Brecht
B
Janssens
Jozef
J
Tack
Jan
J
D015746:Abdominal Pain / Q000503:physiopathology; D000328:Adult; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D001931:Brain Mapping; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002536:Cerebral Arteries / Q000502:physiology; D002540:Cerebral Cortex / Q000503:physiopathology; D002550:Cerebral Veins / Q000502:physiology; D004415:Dyspepsia / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D015905:Gastric Balloon; D013271:Gastric Dilatation / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009325:Nausea / Q000503:physiopathology; D009475:Neurons, Afferent / Q000502:physiology; D020534:Parahippocampal Gyrus / Q000503:physiopathology; D049268:Positron-Emission Tomography; D012039:Regional Blood Flow / Q000502:physiology