title: Mapping of Brain Activations to Rectal Balloon Distension Stimuli in Male Patients with Irritable Bowel Syndrome Using Functional Magnetic Resonance Imaging.
abstract: OBJECTIVE
  Irritable bowel syndrome (IBS) is associated with exaggerated cerebral response including emotional processing following visceral stimulation; though data on this issue is available in female IBS patients, it is scanty among males. Hence, we aimed to study brain response of male IBS patients following rectal balloon distension as compared to healthy controls using functional magnetic resonance imaging (fMRI). Data between diarrhea and constipation predominant IBS (IBS-D and IBS-C) were also compared.
  
  
  METHODS
  Rectal balloon distension threshold was assessed in 20 male IBS patients (10 IBS-C and 10 IBS-D) and 10 age-matched male healthy controls. Subsequently, fMRI on all the participants was performed at their respective rectal pain threshold. The fMRI data were analysed using the Statistical Parametric Mapping software.
  
  
  RESULTS
  IBS patients showed greater cerebral activations in insula, middle temporal gyrus, and cerebellum in the left hemisphere compared to healthy controls. Neural activation was found in bilateral precuneus/superior parietal lobules in controls but not in patients with IBS. The brain activation differed among IBS-C and IBS-D patients; while the right mid-cingulate cortex was activated in IBS-C, the left inferior orbito-frontal cortex, left calcarine, and bilateral fusiform gyri were activated among patients with IBS-D following rectal balloon distension.
  
  
  CONCLUSIONS
  Brain response to rectal balloon distension differed among male patients with IBS and controls and among patients with IBS-C and IBS-D. Differential activation among patients with IBS-C and IBS-D was seen in the brain regions controlling affective motivation, homeostatic emotions, and autonomic responses to pain.
authors.affiliation: Centre of Biomedical Research, SGPGIMS Campus, Lucknow, Uttar Pradesh, India.
authors.forename: Anupam
authors.initials: A
authors.lastname: Guleria
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Karyampudi
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Rajan
authors.initials: R
authors.lastname: Singh
authors.affiliation: Centre of Biomedical Research, SGPGIMS Campus, Lucknow, Uttar Pradesh, India.
authors.forename: Chunni L
authors.initials: CL
authors.lastname: Khetrapal
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Abhai
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Uday C
authors.initials: UC
authors.lastname: Ghoshal
authors.affiliation: Centre of Biomedical Research, SGPGIMS Campus, Lucknow, Uttar Pradesh, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Kumar
keywords: Brain; Irritable bowel syndrome; Magnetic resonance imaging; Pain