Abstract
Recent studies have shown that the brain of patients with gastrointestinal disease differ both structurally and functionally from that of controls. Highly somatizing diverticular disease (HSDD) patients were also shown to differ from low somatizing (LSDD) patients functionally. This study aimed to investigate how they differed structurally. Four diseases subgroups were studied in a cross-sectional design: 20 patients with asymptomatic diverticular disease (ADD), 18 LSDD, 16 HSDD, and 18 with irritable bowel syndrome. We divided DD patients into LSDD and HSDD using a cutoff of 6 on the Patient Health Questionnaire 12 Somatic Symptom (PHQ12-SS) scale. All patients underwent a 1-mm isotropic structural brain MRI scan and were assessed for somatization, hospital anxiety, depression, and pain catastrophizing. Whole brain volumetry, cortical thickness analysis and voxel-based morphometry were carried out using Freesurfer and SPM. We observed decreases in gray matter density in the left and right dorsolateral prefrontal cortex (dlPFC), and in the mid-cingulate and motor cortex, and increases in the left (19, 20) and right (19, 38) Brodmann Areas. The average cortical thickness differed overall across groups (P=.002) and regionally: HSDD>ADD in theposterior cingulate cortex (P=.03), HSDD>LSDD in the dlPFC (P=.03) and in the ventrolateral PFC (P<.001). The thickness of the anterior cingulate cortex and of the mid-prefrontal cortex were also found to correlate with Pain Catastrophizing (Spearman's ρ=0.24, P=.043 uncorrected and Spearman's ρ=0.25, P=.03 uncorrected). This is the first study of structural gray matter abnormalities in diverticular disease patients. The data show brain differences in the pain network.
Highlights
Diverticular disease (DD) of the colon, characterized by mucosal herniation, affects predominantly those over 65 years old and is associated with considerable morbidity
Key cortical brain regions involved in the response to pain include the anterior cingulate cortex (ACC), amygdala (AMYG), hypothalamus (HpTH), the posterior, mid and anterior insula (INS) locus coeruleus (LC), periaqueductal grey (PAG), prefrontal cortex (PFC) including both dorsolateral and orbitofrontal areas, rostroventral medulla (RVM), primary and secondary somatosensory cortices (SI and SII) and the thalamus (Thal)
We used one-way, independent-sample ANOVA and ANCOVA analyses to compare demographic characteristics as well as volumetric and thickness measurements at the global and regional level across patient groups. We focused on those regions identified a priori from the literature, as discussed in the Introduction, i.e. various sub-structures of the cingulate gyrus (ACC, anterior, posterior and dorsal mid cingulate cortex (MCC), PCC), prefrontal cortex, and the insula
Summary
Diverticular disease (DD) of the colon, characterized by mucosal herniation, affects predominantly those over 65 years old and is associated with considerable morbidity. Chronic pain symptoms can be present for prolonged periods of time resulting in an associated reduction in quality of life and increased cost to the health service 4, 5. Visceral pain pathways involve the enteric nervous plexus, signaling to a variety of regions in the brain via afferent tracts through the spine, and back via descending nociceptive inhibitory control mechanisms within the brain 6, 7. There are widespread connections between these areas which are often shown to be activated in brain imaging studies of emotion processing touching upon affective, emotional and somatosensory aspects of pain. Recent studies have shown that the brain of patients with gastrointestinal disease differ both structurally and functionally from that of controls. Somatizing diverticular disease (HSDD) patients were shown to differ from low somatizing (LSDD) patients functionally.
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