Volume 139, Issue 4, Pages 1310-1319.e4 (October 2010) Patients With Irritable Bowel Syndrome Have Altered Emotional Modulation of Neural Responses to Visceral Stimuli  Sigrid Elsenbruch, Christina Rosenberger, Ulrike Bingel, Michael Forsting, Manfred Schedlowski, Elke R. Gizewski  Gastroenterology  Volume 139, Issue 4, Pages 1310-1319.e4 (October 2010) DOI: 10.1053/j.gastro.2010.06.054 Copyright © 2010 AGA Institute Terms and Conditions

Figure 1 State anxiety, measured with the STAI-S, in the psychologic stress condition in IBS patients (A) and healthy controls (B) and in the relaxation condition in IBS patients (C) and healthy controls (D). Both groups demonstrated significant but comparable increases in state anxiety in response to stress and reduced anxiety in response to relaxation (both ANOVA condition effects: P < .01). Note that the prescan assessment in the stress condition was accomplished following negative emotion induction (ie, following speech delivery), whereas the prescan assessment in the relaxation condition was accomplished prior to the initiation of the relaxation. Data are shown as mean ± standard error of mean. Gastroenterology 2010 139, 1310-1319.e4DOI: (10.1053/j.gastro.2010.06.054) Copyright © 2010 AGA Institute Terms and Conditions

Figure 2 Group differences in the modulation of rectal distension-induced cortical activation by psychologic stress. Two-sample t tests computed on contrasts between the psychologic stress and control conditions (IBSstress>rest > Healthstress>rest) overlaid on a structural T1-weighted MRI used for spatial normalization. IBS patients display a stronger modulation of distension-related responses by stress in (A) left insula (x = −40; y = −2, z = −6), left ventrolateral prefrontal cortex (x = −48, y = 36, z = 28), and left midcingulate cortex (x = −2, y = 20; z = 26) during nonpainful distensions and (B) the right insula (x = 44, y = 4, z = 8) and left ventromedial prefrontal cortex (x = −42, y = 34, z = 12) during painful distensions. (C) IBS patients showed reduced modulation (IBSstress>rest < Healthstress>rest) in the right dorsolateral prefrontal cortex (x = 30, y = 48, z = 14) and right subgenual anterior cingulate cortex (x = 8, y = 24, z = 14) during painful distensions. All P values were < .05 with family-wise error correction for multiple comparisons; for more details, see Table 3. The images are thresholded at P < .005 uncorrected for visualization purposes. Gastroenterology 2010 139, 1310-1319.e4DOI: (10.1053/j.gastro.2010.06.054) Copyright © 2010 AGA Institute Terms and Conditions

Figure 3 Group differences in the modulation of distension-induced cortical activation by relaxation. Two-sample t tests computed on contrasts between the relaxation and control conditions (IBSrelaxation>rest < Healthrelaxation>rest) overlaid on a structural T1-weighted MRI used for spatial normalization. Two-sample t tests computed on contrasts between the relaxation and control conditions revealed less modulation in IBS patients in the right insula (x = 48, y = −12; z = 16, all P values < .05 with family-wise error correction for multiple comparisons) during nonpainful distensions when compared with modulation in healthy subjects. The images are thresholded at P < .005 uncorrected for visualization purposes. Gastroenterology 2010 139, 1310-1319.e4DOI: (10.1053/j.gastro.2010.06.054) Copyright © 2010 AGA Institute Terms and Conditions