Faculty Collaboration Database

Neurocognitive processing of esophageal central sensitization in the insula and cingulate gyrus. Am J Physiol Gastrointest Liver Physiol 2008 Mar;294(3):G787-94

Date

01/12/2008

Pubmed ID

18187518

DOI

10.1152/ajpgi.00421.2007

Scopus ID

2-s2.0-41549084157 (requires institutional sign-in at Scopus site)   38 Citations

Abstract

The cingulate and insular cortices are parts of the limbic system that process and modulate gastrointestinal sensory signals. We hypothesized that sensitization of these two limbic area may operate in esophageal sensitization. Thus the objective of the study was to elucidate the neurocognitive processing in the cingulate and insular cortices to mechanical stimulation of the proximal esophagus following infusion of acid or phosphate buffer solution (PBS) into the esophagus. Twenty-six studies (14 to acid and 12 to PBS infusion) were performed in 20 healthy subjects (18-35 yr) using high-resolution (2.5 x 2.5 x 2.5 mm(3) voxel size) functional MRI (fMRI). Paradigm-driven, 2-min fMRI scans were performed during randomly timed 15-s intervals of proximal esophageal barostatically controlled distentions and rest, before and after 30-min of distal esophageal acid or PBS perfusion (0.1 N HCl or 0.1 M PBS at 1 ml/min). Following distal esophageal acid infusion, at subliminal and liminal levels of proximal esophageal distentions, the number of activated voxels in both cingulate and insular cortices showed a significant increase compared with before acid infusion (P < 0.05). No statistically significant change in cortical activity was noted following PBS infusion. We conclude that 1) acid stimulation of the esophagus results in sensitization of the cingulate and insular cortices to subliminal and liminal nonpainful mechanical stimulations, and 2) these findings can have ramifications with regard to the mechanisms of some esophageal symptoms attributed to reflux disease.

Author List

Lawal A, Kern M, Sanjeevi A, Antonik S, Mepani R, Rittmann T, Hussaini S, Hofmann C, Tatro L, Jesmanowicz A, Verber M, Shaker R

Author

Reza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Catheterization
Cerebral Cortex
Cognition
Dilatation
Esophagus
Female
Gastroesophageal Reflux
Gyrus Cinguli
Humans
Hydrochloric Acid
Hydrogen-Ion Concentration
Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Male
Nerve Net
Pain
Physical Stimulation
Stimulation, Chemical