J Neurogastroenterol Motil  
Mapping of Brain Activations to Rectal Balloon Distension Stimuli in Male Patients with Irritable Bowel Syndrome Using Functional Magnetic Resonance Imaging
Anupam Guleria,1* Arun Karyampudi,2 Rajan Singh,2 Chunni L Khetrapal,1 Abhai Verma,2 Uday C Ghoshal,2* and Dinesh Kumar1
1Centre of Biomedical Research, SGPGIMS Campus and 2Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Correspondence to: Anupam Guleria, PhD
Centre of Biomedical Research, SGPGIMS Campus, Raebareli Road, Lucknow 226014, Uttar Pradesh, India
Tel: +91-522-2495034, Fax: +91-522-2668215, E-mail: anuguleriaphy@gmail.com
Uday C Ghoshal, MD, DNB, DM, FACG, RFF
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
Fax: +91-522-2668017 (or 2668078), E-mail: udayghoshal@gmail.com
Anupam Guleria and Arun Karyampudi contributed equally to this study.
Received: June 26, 2016; Revised: December 25, 2016; Accepted: December 26, 2016; Published online: February 14, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Irritable bowel syndrome (IBS) is associated with exaggerated cerebral response including emotional processing following visceral stimulation; though data on this issue is available in female IBS patients, it is scanty among male. Hence, we aimed to study brain response of male IBS patients following rectal balloon distension as compared to healthy controls using functional magnetic resonance imaging (fMRI). Data between diarrhea and constipation predominant IBS (IBS-D and IBS-C) were also compared.
Methods
Rectal balloon distension threshold was assessed in 20 male IBS patients (10 IBS-C and 10 IBS-D) and 10 age-matched male healthy controls. Subsequently, fMRI on all the participants was performed at their respective rectal pain threshold. The fMRI data were analysed using Statistical Parametric Mapping software.
Results
IBS patients showed greater cerebral activations in insula, middle temporal gyrus, and cerebellum in left hemisphere compared to healthy controls. Neural activation was found in bilateral precuneus/superior parietal lobule in controls but not in patients with IBS. The brain activation differed among IBS-C and IBS-D patients; while right mid-cingulate cortex was activated in IBS-C, left inferior orbito-frontal cortex, left calcarine, and bilateral fusiform gyrus were activated among patients with IBS-D following rectal balloon distension.
Conclusions
Brain response to rectal balloon distension differed among male patients with IBS and controls and among patients with IBS-C and IBS-D. Differential activation among patients with IBS-C and IBS-D were seen in the brain regions controlling affective motivation, homeostatic emotions, and autonomic responses to pain.
Keywords: Brain; Irritable Bowel Syndrome; Magnetic resonance Imaging; Pain


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