title: Abdominal Pain, the Adolescent and Altered Brain Structure and Function.
abstract: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology. Although relatively common in children, how this condition affects brain structure and function in a pediatric population remains unclear. Here, we investigate brain changes in adolescents with IBS and healthy controls. Imaging was performed with a Siemens 3 Tesla Trio Tim MRI scanner equipped with a 32-channel head coil. A high-resolution T1-weighted anatomical scan was acquired followed by a T2-weighted functional scan. We used a surface-based morphometric approach along with a seed-based resting-state functional connectivity (RS-FC) analysis to determine if groups differed in cortical thickness and whether areas showing structural differences also showed abnormal RS-FC patterns. Patients completed the Abdominal Pain Index and the GI Module of the Pediatric Quality of Life Inventory to assess abdominal pain severity and impact of GI symptoms on health-related quality of life (HRQOL). Disease duration and pain intensity were also assessed. Pediatric IBS patients, relative to controls, showed cortical thickening in the posterior cingulate (PCC), whereas cortical thinning in posterior parietal and prefrontal areas were found, including the dorsolateral prefrontal cortex (DLPFC). In patients, abdominal pain severity was related to cortical thickening in the intra-abdominal area of the primary somatosensory cortex (SI), whereas HRQOL was associated with insular cortical thinning. Disease severity measures correlated with cortical thickness in bilateral DLPFC and orbitofrontal cortex. Patients also showed reduced anti-correlations between PCC and DLPFC compared to controls, a finding that may reflect aberrant connectivity between default mode and cognitive control networks. We are the first to demonstrate concomitant structural and functional brain changes associated with abdominal pain severity, HRQOL related to GI-specific symptoms, and disease-specific measures in adolescents with IBS. It is possible such changes will be responsive to therapeutic intervention and may be useful as potential markers of disease progression or reversal.
authors.affiliation: Center for Pain and the Brain, Boston Children's Hospital, Waltham, Massachusetts, United States of America.|Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.|Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Catherine S
authors.identifier: http://orcid.org/0000-0002-9139-2198
authors.initials: CS
authors.lastname: Hubbard
authors.affiliation: Center for Pain and the Brain, Boston Children's Hospital, Waltham, Massachusetts, United States of America.|Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.|Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Lino
authors.initials: L
authors.lastname: Becerra
authors.affiliation: Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Nicole
authors.initials: N
authors.lastname: Heinz
authors.affiliation: Center for Pain and the Brain, Boston Children's Hospital, Waltham, Massachusetts, United States of America.
authors.forename: Allison
authors.initials: A
authors.lastname: Ludwick
authors.affiliation: Center for Pain and the Brain, Boston Children's Hospital, Waltham, Massachusetts, United States of America.
authors.forename: Tali
authors.initials: T
authors.lastname: Rasooly
authors.affiliation: Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Rina
authors.initials: R
authors.lastname: Wu
authors.affiliation: Center for Pain and the Brain, Boston Children's Hospital, Waltham, Massachusetts, United States of America.
authors.forename: Adriana
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.|Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Neil L
authors.initials: NL
authors.lastname: Schechter
authors.affiliation: Center for Pain and the Brain, Boston Children's Hospital, Waltham, Massachusetts, United States of America.|Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.|Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Borsook
authors.affiliation: Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
mesh_terms: D015746:Abdominal Pain / Q000503:physiopathology*; D000293:Adolescent; D001931:Brain Mapping / Q000379:methods*; D002540:Cerebral Cortex / Q000503:physiopathology*; D002648:Child; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009434:Neural Pathways / Q000503:physiopathology*; D017397:Prefrontal Cortex / Q000503:physiopathology*