A bi-directional assessment of the human brain-anorectal axis.
BACKGROUND
Brain-gut dysfunction has been implicated in gastrointestinal disorders but a comprehensive test of brain-gut axis is lacking. We developed and tested a novel method for assessing both afferent anorectal-brain function using cortical evoked potentials (CEP), and efferent brain-anorectal function using motor evoked potentials (MEP).


METHODS
Cortical evoked potentials was assessed following electrical stimulations of anus and rectum with bipolar electrodes in 26 healthy subjects. Anorectal MEPs were recorded following transcranial magnetic stimulation (TMS) over paramedian motor cortices bilaterally. Anal and rectal latencies/amplitudes for CEP and MEP responses and thresholds for first sensation and pain (mA) were analyzed and compared. Reproducibility and interobserver agreement of responses were examined.


RESULTS
Reproducible polyphasic rectal and anal CEPs were recorded in all subjects, without gender differences, and with negative correlation between BMI and CEP amplitude (r -0.66, P=0.001). Transcranial magnetic stimulation evoked triphasic rectal and anal MEPs, without gender differences. Reproducibility for CEP and MEP was excellent (CV <10%). The inter-rater CV for anal and rectal MEPs was excellent (ICC 97-99), although there was inter-subject variation.


CONCLUSIONS
Combined CEP and MEP studies offer a simple, inexpensive and valid method of examining bidirectional brain-anorectal axes. This comprehensive method could provide mechanistic insights into lower gut disorders.
Division of Neurogastroenterology and Motility, Department of Internal Medicine and Clinical Translational Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
J M
JM
Remes-Troche
K
K
Tantiphlachiva
A
A
Attaluri
J
J
Valestin
T
T
Yamada
S
S
Hamdy
S S C
SS
Rao
D000328:Adult; D001003:Anal Canal / Q000294:innervation / Q000502:physiology*; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000502:physiology*; D004558:Electric Stimulation; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000294:innervation / Q000502:physiology*; D015203:Reproducibility of Results; D012684:Sensory Thresholds; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult