J Neurogastroenterol Motil.  2018 Apr;24(2):268-279. 10.5056/jnm17076.

Regional Brain Activity During Rest and Gastric Water Load in Subtypes of Functional Dyspepsia: A Preliminary Brain Functional Magnetic Resonance Imaging Study

Affiliations
  • 1Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. kemypumch2006@aliyun.com
  • 2Department of Gastroenterology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
  • 3Department of Gastroenterology, No.4 Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang Province, China.
  • 4Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Abstract

BACKGROUND/AIMS
Functional dyspepsia (FD) remains a great clinical challenge since the FD subtypes, defined by Rome III classification, still have heterogeneous pathogenesis. Previous studies have shown notable differences in visceral sensation processing in the CNS in FD compared to healthy subjects (HS). However, the role of CNS in the pathogenesis of each FD subtype has not been recognized.
METHODS
Twenty-eight FD patients, including 10 epigastric pain syndrome (EPS), 9 postprandial distress syndrome (PDS), and 9 mixed-type, and 10 HS, were enrolled. All subjects underwent a proximal gastric perfusion water load test and the regional brain activities during resting state and water load test were investigated by functional magnetic resonance imaging.
RESULTS
For regional brain activities during the resting state and water load test, each FD subtype was significantly different from HS (P < 0.05). Focusing on EPS and PDS, the regional brain activities of EPS were stronger than PDS in the left paracentral lobule, right inferior frontal gyrus pars opercularis, postcentral gyrus, precuneus, insula, parahippocampal gyrus, caudate nucleus, and bilateral cingulate cortices at the resting state (P < 0.05), and stronger than PDS in the left inferior temporal and fusiform gyri during the water load test (P < 0.05).
CONCLUSIONS
Compared to HS, FD subtypes had different regional brain activities at rest and during water load test, whereby the differences displayed distinct manifestations for each subtype. Compared to PDS, EPS presented more significant differences from HS at rest, suggesting that the abnormality of central visceral pain processing could be one of the main pathogenesis mechanisms for EPS.

Keyword

Dyspepsia; Epigastric pain syndrome; Functional neuroimaging; Post-prandial distress syndrome; Regional homogeneity

MeSH Terms

Brain*
Broca Area
Caudate Nucleus
Classification
Dyspepsia*
Functional Neuroimaging
Healthy Volunteers
Humans
Magnetic Resonance Imaging*
Parahippocampal Gyrus
Parietal Lobe
Perfusion
Prefrontal Cortex
Sensation
Somatosensory Cortex
Visceral Pain
Water*
Water
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