Abstract
Background: Crohn’s disease (CD) is a subtype of inflammatory bowel disease caused by immune-mediated inflammation in the gastrointestinal tract. The extent of morphologic brain alterations and their associated cognitive and affective impairments remain poorly characterized.Aims: We used magnetic resonance imaging to identify structural brain differences between patients with Crohn’s disease in remission compared to age-matched healthy controls and evaluated for structural-behavioral correlates.Methods: Nineteen patients and 20 healthy, age-matched controls were recruited in the study. Group differences in brain morphometric measures and correlations between brain measures and performance on a cognitive task, the verbal fluency (VF) task, were examined. Correlations between brain measures and cognitive measures as well as self-reported measures of depression, personality, and affective scales were examined.Results: Patients showed significant cortical thickening in the left superior frontal region compared to controls. Significant group differences were observed in sub-cortical volume measures in both hemispheres. Investigation of brain-behavior correlations revealed significant group differences in the correlation between cortical surface area and VF performance, although behavioral performance was equivalent between the two groups. The left middle temporal surface area was a significant predictor of VF performance with controls showing a significant positive correlation between these measures, and patients showing the opposite effect.Conclusion: Our results indicate key differences in structural brain measures in patients with CD compared to controls. Additionally, correlation between brain measures and behavioral responses suggest there may be a neural basis to the alterations in patients’ cognitive and affective responses.
Highlights
It is widely postulated that alterations in brain-gut communication underlie the pathophysiology of irritable bowel syndrome (IBS) wherein altered transmission of sensory nerve pathways from the periphery to the brain results in visceral hypersensitivity (Mayer and Tillisch, 2011)
There is evidence that patients with IBS as well as other chronic pain syndromes such as fibromyalgia, chronic low back pain, and headache/migraine (May, 2008; Blankstein et al, 2010; Seminowicz et al, 2010; Schwedt et al, 2015) have structural brain abnormalities including regional cortical thickening and thinning and gray matter density changes compared to healthy individuals
Patients with chronic inflammatory conditions such as chronic pancreatitis and rheumatoid arthritis demonstrate structural changes including reduced cortical thickness in the brain areas involved with pain processing and altered subcortical gray matter content in the basal ganglia, respectively (Frokjaer et al, 2012; Wartolowska et al, 2012)
Summary
It is widely postulated that alterations in brain-gut communication underlie the pathophysiology of irritable bowel syndrome (IBS) wherein altered transmission of sensory nerve pathways from the periphery to the brain results in visceral hypersensitivity (Mayer and Tillisch, 2011). Recent studies suggest that the inflammatory state of Crohn’s disease (CD), one of the main phenotypes of inflammatory bowel disease (IBD), may be associated with altered sensory processing. In patients with CD, intestinal inflammatory signals may reach the brain via inflammatory cytokines and cause a cascade of neuroplastic events resulting in alterations in the anatomical and functional substrates of the brain impacting cognitive and affective processing. A recent functional magnetic resonance imaging (fMRI) brain study in patients with active CD therapy revealed decreased pain perception in the brain upon neutralization of the pro-inflammatory cytokine tumor necrosis factor alpha (TNFα; Hess et al, 2015). Crohn’s disease (CD) is a subtype of inflammatory bowel disease caused by immune-mediated inflammation in the gastrointestinal tract. The extent of morphologic brain alterations and their associated cognitive and affective impairments remain poorly characterized
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
