Document Detail

Neurocognitive processing of esophageal central sensitization in the insula and cingulate gyrus.
MedLine Citation:
PMID:  18187518     Owner:  NLM     Status:  MEDLINE    
The cingulate and insular cortices are parts of the limbic system that process and modulate gastrointestinal sensory signals. We hypothesized that sensitization of these two limbic area may operate in esophageal sensitization. Thus the objective of the study was to elucidate the neurocognitive processing in the cingulate and insular cortices to mechanical stimulation of the proximal esophagus following infusion of acid or phosphate buffer solution (PBS) into the esophagus. Twenty-six studies (14 to acid and 12 to PBS infusion) were performed in 20 healthy subjects (18-35 yr) using high-resolution (2.5 x 2.5 x 2.5 mm(3) voxel size) functional MRI (fMRI). Paradigm-driven, 2-min fMRI scans were performed during randomly timed 15-s intervals of proximal esophageal barostatically controlled distentions and rest, before and after 30-min of distal esophageal acid or PBS perfusion (0.1 N HCl or 0.1 M PBS at 1 ml/min). Following distal esophageal acid infusion, at subliminal and liminal levels of proximal esophageal distentions, the number of activated voxels in both cingulate and insular cortices showed a significant increase compared with before acid infusion (P < 0.05). No statistically significant change in cortical activity was noted following PBS infusion. We conclude that 1) acid stimulation of the esophagus results in sensitization of the cingulate and insular cortices to subliminal and liminal nonpainful mechanical stimulations, and 2) these findings can have ramifications with regard to the mechanisms of some esophageal symptoms attributed to reflux disease.
Adeyemi Lawal; Mark Kern; Arthi Sanjeevi; Stephen Antonik; Rachel Mepani; Tanya Rittmann; Syed Hussaini; Candy Hofmann; Linda Tatro; Andrzej Jesmanowicz; Matt Verber; Reza Shaker
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2008-01-10
Journal Detail:
Title:  American journal of physiology. Gastrointestinal and liver physiology     Volume:  294     ISSN:  0193-1857     ISO Abbreviation:  Am. J. Physiol. Gastrointest. Liver Physiol.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-06     Completed Date:  2008-05-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100901227     Medline TA:  Am J Physiol Gastrointest Liver Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  G787-94     Citation Subset:  IM    
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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MeSH Terms
Cerebral Cortex / physiology*
Cognition / physiology*
Esophagus / innervation*,  physiology*
Gastroesophageal Reflux / physiopathology
Gyrus Cinguli / physiology*
Hydrochloric Acid / pharmacology
Hydrogen-Ion Concentration
Image Processing, Computer-Assisted
Magnetic Resonance Imaging
Nerve Net / physiology
Pain / physiopathology
Physical Stimulation
Stimulation, Chemical
Grant Support
Reg. No./Substance:
7647-01-0/Hydrochloric Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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