© 2003 by BMJ Publishing Group Ltd & British Society of Gastroenterology
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Pain and disturbed function of the oesophagus, stomach and intestine are common symptoms but in many patients, conventional tests are all normal. Recent evidence suggests that the symptoms may arise from a hypersensitivity to stimuli from the gut. This visceral hypersensitivity may be due to either increased signalling from the gut or to altered central processing of such signals. Aziz and colleagues have used functional magnetic resonance imaging to examine central processing. They instructed their subjects to selectively attend to either visual or oesophageal stimuli which were produced by distending a balloon in the mid-oesophagus. They showed that while the visual stimuli activate the visual cortex only, the rather novel oesophageal stimulus activated substantially more areas of the brain, including areas such as the anterior cingulated and prefrontal cortex which are associated with affect and cognition. Furthermore, when both stimuli were presented simultaneously the areas of the brain processing the
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