title: Patients with irritable bowel syndrome have altered emotional modulation of neural responses to visceral stimuli.
abstract: OBJECTIVE
  In patients with irritable bowel syndrome (IBS), pain amplification and hypervigilance might result from altered affective-motivational modulation of the pain response. We investigated the effects of emotional context on the behavioral and neural response to visceral stimuli in IBS patients.
  
  
  METHODS
  We used functional magnetic resonance imaging (fMRI) to assess the blood oxygen level-dependent response to nonpainful and painful rectal distensions in 15 female IBS patients and 12 healthy women. Distensions were delivered during psychologic stress or relaxation; data were compared with those in a neutral condition (control). Group and context-dependent differences in the processing of visceral stimulation were assessed at behavioral and the neuronal levels. Secondary analyses of group differences were performed using anxiety scores as a covariate because of higher anxiety symptoms among patients with IBS.
  
  
  RESULTS
  During rectal stimulation, IBS patients demonstrated more pronounced stress-induced modulation of neural activation in multiple brain regions, including the insula, midcingulate cortex, and ventrolateral prefrontal cortex. In response to relaxation, IBS patients demonstrated reduced modulation of distension-induced activation in the insula. During relaxation, the difference observed between groups could be accounted for by higher anxiety symptoms in patients with IBS; differential effects of stress in the insula and prefrontal regions were not attributable to anxiety.
  
  
  CONCLUSIONS
  IBS patients appear to have disrupted emotional modulation of neural responses to visceral stimuli, possibly reflecting the neural basis for altered visceral interoception by stress and negative emotions.
authors.affiliation: Institute of Medical Psychology and Behavioral Immunobiology, University Clinic of Essen, University of Duisburg-Essen, Essen, Germany. sigrid.elsenbruch@uk-essen.de
authors.forename: Sigrid
authors.initials: S
authors.lastname: Elsenbruch
authors.forename: Christina
authors.initials: C
authors.lastname: Rosenberger
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bingel
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.forename: Manfred
authors.initials: M
authors.lastname: Schedlowski
authors.forename: Elke R
authors.initials: ER
authors.lastname: Gizewski
mesh_terms: D000328:Adult; D001921:Brain / Q000502:physiology*; D004644:Emotions; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000503:physiopathology* / Q000523:psychology*; D009126:Muscle Relaxation; D017288:Pain Threshold; D017397:Prefrontal Cortex / Q000502:physiology; D013315:Stress, Psychological / Q000523:psychology; D014781:Viscera / Q000503:physiopathology*