Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology. Although relatively common in children, how this condition affects brain structure and function in a pediatric population remains unclear. Here, we investigate brain changes in adolescents with IBS and healthy controls. Imaging was performed with a Siemens 3 Tesla Trio Tim MRI scanner equipped with a 32-channel head coil. A high-resolution T1-weighted anatomical scan was acquired followed by a T2-weighted functional scan. We used a surface-based morphometric approach along with a seed-based resting-state functional connectivity (RS-FC) analysis to determine if groups differed in cortical thickness and whether areas showing structural differences also showed abnormal RS-FC patterns. Patients completed the Abdominal Pain Index and the GI Module of the Pediatric Quality of Life Inventory to assess abdominal pain severity and impact of GI symptoms on health-related quality of life (HRQOL). Disease duration and pain intensity were also assessed. Pediatric IBS patients, relative to controls, showed cortical thickening in the posterior cingulate (PCC), whereas cortical thinning in posterior parietal and prefrontal areas were found, including the dorsolateral prefrontal cortex (DLPFC). In patients, abdominal pain severity was related to cortical thickening in the intra-abdominal area of the primary somatosensory cortex (SI), whereas HRQOL was associated with insular cortical thinning. Disease severity measures correlated with cortical thickness in bilateral DLPFC and orbitofrontal cortex. Patients also showed reduced anti-correlations between PCC and DLPFC compared to controls, a finding that may reflect aberrant connectivity between default mode and cognitive control networks. We are the first to demonstrate concomitant structural and functional brain changes associated with abdominal pain severity, HRQOL related to GI-specific symptoms, and disease-specific measures in adolescents with IBS. It is possible such changes will be responsive to therapeutic intervention and may be useful as potential markers of disease progression or reversal.
Highlights
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by chronic abdominal pain and/or discomfort, and accompanied by altered bowel patterns [1, 2]
The PedsQL was negatively correlated with pain catastrophizing scores from the PCS (r = -.62, p = .04). These findings indicate that pediatric IBS patients reporting lower health-related quality of life (HRQOL), reported greater functional disability associated with their symptoms, greater overall mood disturbances, and a greater propensity to catastrophize about their pain
In contrast to previous findings reported by Blankstein et al (2010) demonstrating cortical thinning in the anterior insula (aINS) associated with longer disease durations in adult patients with IBS, we found no significant relationship between cortical thickness and disease duration for this brain region [46]
Summary
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by chronic abdominal pain and/or discomfort, and accompanied by altered bowel patterns [1, 2]. More frequently studied and reported in adults, this syndrome affects children and adolescents and is associated with the occurrence of early, adverse life events, and the development of mood and somatoform disorders into adulthood [3,4,5]. IBS represents an important clinical problem in children that needs to be addressed since identifying effective treatments for this syndrome would be lifealtering for many. IBS is considered a ‘functional disorder’ given that alterations in bowel function and associated symptoms manifest in absence of any apparent structural or biochemical disease process. The availability of such markers would form a basis of enhanced phenotyping of the disease state, provide an earlier diagnosis, reduce costs associated with unnecessary and expensive testing, and provide valuable information to researchers and clinicians in search of novel and effective treatments
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