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Abnormal brain microstructure in patients with chronic pancreatitis
  1. Bruno Bonaz
  1. Correspondence to Professor Bruno Bonaz, Department of Gastroenterology and Liver Diseases, CHU Grenoble, BP217, 38043 Grenoble Cedex 09, France; bbonaz{at}chu-grenoble.fr

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The emergence of brain imaging studies has allowed a better knowledge of pain processing in the central nervous system in both normal and pathological conditions. In particular, abnormal loci of activation have been demonstrated in areas of the ‘pain matrix’ involved in sensory-discriminative (primary sensory and insular cortices), affective (anterior cingulate cortex), cognitive (prefrontal cortex) and limbic (amygdala) components in patients with chronic abdominal pain as observed in irritable bowel syndrome (IBS).1 A widespread aberrant central processing of pain (central sensitisation) is observed in these patients.2 In addition, abnormal structural grey matter integrity in IBS that correlates with individual disease symptoms, duration of IBS or the personality characteristic of pain catastrophising has been reported.3 With the development of magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI), it has been possible to assess changes in white and grey matter microstructure not seen by more conventional imaging techniques.4 DTI has become a popular method to assess white matter integrity and connectivity in the brain, and a DTI-derived value called fractional anisotropy is often examined as a measure of microstructural white matter integrity. Using DTI, white matter abnormalities in the insula, anterior cingulate cortex and other brain areas associated …

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