Increased attentional network functioning related to symptom severity measures in females with irritable bowel syndrome

Hubbard CS1,2,3,4, Hong J1,2,5,6, Jiang Z1, Ebrat B1,2, Suyenobu B1,2, Smith S1,2, Heendeniya N1,2, Naliboff BD1,2,6,7,8, Tillisch K1,2,6, Mayer EA1,2,6,9,8, Labus JS1,2,6,8. Neurogastroenterol Motil. 2015 Jun 19. doi: 10.1111/nmo.12622. [Epub ahead of print]
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1Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, UCLA, Los Angeles, CA, USA. 2Department of Medicine, UCLA, Los Angeles, CA, USA. 3Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA. 4Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, USA. 5Biomedical Engineering, UCLA, Los Angeles, CA, USA. 6Pain and Interoceptive Network (PAIN), Los Angeles, CA, USA. 7VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 8Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA. 9Department of Physiology, UCLA, Los Angeles, CA, USA.


BACKGROUND: Increased attention to gastrointestinal (GI) symptoms and disease-specific contexts may play an important role in the enhanced perception of visceral stimuli frequently reported in patients with irritable bowel syndrome (IBS). In this study, we test the hypothesis that altered attentional mechanisms underlie central pain amplification in IBS.

METHODS: To evaluate brain networks that support alerting, orienting, and executive attention, we employed the attention network test (ANT), a modified flanker task which measures the efficiency of functioning of core attentional networks, during functional magnetic resonance imaging in 15 IBS patients (mean age = 31 [11.96]) and 14 healthy controls (HCs; mean age = 31 [10.91]).

KEY RESULTS: Patients with IBS, compared to HCs, showed shorter reaction times during the alerting and orienting conditions which were associated with greater activation of anterior midcingulate and insular cortices, and decreased activity in the right inferior frontal junction and supplementary motor cortex. Patients also showed activation in the dorsal medial prefrontal cortex and concurrent thalamic deactivation during the executive control portion of the ANT relative to HCs, but no group difference in reaction times were found. The activity in brain regions showing group differences during the ANT were associated with measures of GI-specific anxiety, pain catastrophizing, and fear of uncertainty. In IBS, activity in the anterior midcingulate during alerting correlated with duration of GI-symptoms and overall symptom severity.

CONCLUSIONS & INFERENCES: Together, these results suggest that IBS patients have specific abnormalities in attentional network functioning and these deficits may underlie symptom-related anxiety, hypervigilance, and visceral hypersensitivity.

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