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- Brain imaging
- brain–gut interaction
- functional gastrointestinal disorders
Despite rapidly growing evidence supporting a link between psychological processes—both cognitive and affective—and visceral sensation in health as well as functional gastrointestinal disorders (FGIDs), the neural mechanisms underlying these interactions remain infrequently studied within the field of ‘neurogastroenterology’ and therefore rather poorly understood.1 The somatic pain field, in contrast, has already made considerable progress in unravelling these complex brain mechanisms by which emotion (eg, anxiety) and cognition (eg, attention) influence the processing and perception of bodily signals.2 More specifically, the amygdala, insula, and cingulate and prefrontal subregions have been shown to be involved in pain–emotion interactions. This knowledge is the result of a fruitful integration between different branches of science within the somatic pain field over the past decades, including psychology, psychiatry, anaesthesiology and the affective, cognitive and sensory branches of neuroscience. Such a degree of integration has not been achieved yet within ‘visceral sensory neuroscience’ but is, in my opinion, much needed if we really want to move the field forward. This may be especially critical if we want to make progress in the understanding of the multifactorial pathophysiology of complex, symptom-based disorders including FGIDs. Although rather sparse, recent attempts towards such integration have been made, and I will try to situate these against a long tradition of studying the interactions between mind, brain and body underlying visceral sensation.
In the present issue of Gut, Elsenbruch and colleagues (see page 489) report on a functional MRI study showing that, in irritable bowel syndrome (IBS), anxiety and …