Gastroenterology

Gastroenterology

Volume 120, Issue 2, February 2001, Pages 369-376
Gastroenterology

Alimentary Tract
Gastric distention correlates with activation of multiple cortical and subcortical regions☆☆

https://doi.org/10.1053/gast.2001.21201Get rights and content

Abstract

Background & Aims: The pathophysiology of functional dyspepsia may involve abnormal processing of visceral stimuli at the level of the central nervous system. There is accumulating evidence that visceral and somatic pain processing in the brain share common neuronal substrates. However, the cerebral loci that process sensory information from the stomach are unknown. The aim of this study was to localize the human brain regions that are activated by gastric distention. Methods: Brain 15O-water positron emission tomography was performed in 15 right-handed healthy volunteers during baseline and distal gastric distentions to 10 mm Hg, 20 mm Hg, threshold pain, and moderate pain. Pain, nausea, and bloating were rated during baseline and distentions (0–5 scale). Statistical subtraction analysis of brain images was performed between distentions and baseline. Results: Symptoms increased with distending stimulus intensity (maximum pain, 2.1 ± 0.4; nausea, 2.2 ± 0.4; bloating, 3.7 ± 0.2). Paralleling increases in distention stimulus and symptoms, progressive increases in activation (P ≤ 0.05), were observed in the thalami, insula bilaterally, anterior cingulate cortex, caudate nuclei, brain stem periaqueductal gray matter, cerebellum, and occipital cortex. Conclusions: Symptomatic gastric distention activates structures implicated in somatic pain processing, supporting the notion of a common cerebral pain network.

GASTROENTEROLOGY 2001;120:369-376

Section snippets

Study population

Fifteen healthy, right-handed volunteers (9 women; age range, 21–49 years) gave written informed consent and were studied. No volunteer was pregnant, had a history of diabetes, gastrointestinal, or psychiatric illness, or was taking medication affecting gastrointestinal function or pain perception or medication used to treat nausea. Screening neurologic examinations were normal in all subjects. The University of Michigan Institutional Review Board approved the protocol.

Isobaric gastric distention

We chose to study distal

Symptoms elicited by distal gastric distention

The distending pressures (mean ± SD) achieved were 22 ± 8 mm Hg with “threshold pain” and 31 ± 8 mm Hg with “moderate pain.” Pain, nausea, and bloating intensity rose with increasing distending pressures (Figure 1).

. Pain, nausea, and bloating scores (mean ± SD) during distal gastric distention. Symptoms were rated on a scale from 0 to 5. Distending pressures during threshold pain (22 ± 8 mm Hg) and moderate pain (31 ± 8 mm Hg) were individualized for each subject in attempts to elicit pain

Discussion

This study identifies a group of cortical and subcortical structures that are activated during symptomatic gastric distention. The cerebral processing of afferent stimuli originating in the internal organs has been investigated less extensively than somatic sensation. The findings of this study augment previous reports on cardiac,10, 11 esophageal,13, 22 and rectal12 pain in characterizing cerebral activation patterns associated with visceral sensation.

Numerous studies have identified a series

References (41)

  • JC Hsieh et al.

    Traumatic nociceptive pain activates the hypothalamus and the periaqueductal gray: a positron emission tomography study

    Pain

    (1996)
  • E Farkas et al.

    Periaqueductal gray matter input to cardiac-related sympathetic premotor neurons

    Brain Res

    (1998)
  • EH Chudler et al.

    The role of the basal ganglia in nociception and pain

    Pain

    (1995)
  • JC Hsieh et al.

    Central representation of chronic ongoing neuropathic pain studied by positron emission tomography

    Pain

    (1995)
  • PE Paulson et al.

    Gender differences in pain perception and patterns of cerebral activation during noxious heat stimulation in humans

    Pain

    (1998)
  • M Lemann et al.

    Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. The irritable stomach syndrome

    Dig Dis Sci

    (1991)
  • M Bradette et al.

    Visceral perception in health and functional dyspepsia. Crossover study of gastric distension with placebo and domperidone

    Dig Dis Sci

    (1991)
  • JD Talbot et al.

    Multiple representations of pain in human cerebral cortex

    Science

    (1991)
  • RC Coghill et al.

    Distributed processing of pain and vibration by the human brain

    J Neurosci

    (1994)
  • KL Casey et al.

    Comparison of human cerebral activation pattern during cutaneous warmth, heat pain, and deep cold pain

    J Neurophysiol

    (1996)

    • Cited by (0)

    ☆☆

    Supported by National Institutes of Health grants M01-RR00042 to the University of Michigan General Clinical Research Center and M01-RR00079 to the University of California, San Francisco General Clinical Research Center (a Clinical Associate Physician Award to U.L.); and a Glaxo Wellcome Institute for Digestive Health Clinical Research Award (to U.L.).

    2

    fax: (415) 502-6714.

    View full text
    Copyright © 2001 American Gastroenterological Association. Published by Elsevier Inc. All rights reserved.