Brain imaging to identify physical reasons why IBS symptoms improve with drug-free treatments

BUFFALO, NY – Patients who suffer from the painful, often disabling, symptoms of irritable bowel syndrome (IBS) often are surprised to find that behavioral changes, not drugs, provide significant relief.

Now, researchers at the University at Buffalo who have pioneered some of these behavioral treatments, along with colleagues at the University of California, Los Angeles, and Northwestern University, are using functional and structural magnetic resonance imaging (MRI) to reveal the biological basis for the relief. The research could help doctors choose the best treatment method for individual patients and could improve the quality of life for millions of people with IBS.

“We’re going to look at biological mechanisms that underlie these non-drug treatments, to discover what is going on in the brain that explains treatment benefits achieved by teaching patients specific skills to control and reduce their symptoms,” says Jeffrey M. Lackner, PhD, associate professor of medicine at the UB School of Medicine and Biomedical Sciences and a project principal investigator. “By using a brain scan to compare brain activity before and after treatment, we expect to get a picture of changes in the brain that correspond to improvements in gastrointestinal symptoms.”

The work is funded by a $2.3 million grant to UCLA, the lead institution; Northwestern; and UB by the National Institute of Diabetes and Digestive and Kidney Diseases. It builds on the work of UCLA researchers at its Oppenheimer Family Center for Neurobiology of Stress and a pilot neuroimaging study conducted by Lackner and colleagues at UB.

The brain imaging study came about partly as a result of a major, $8.9 million, seven-year, multi-site clinical trial Lackner is leading at UB to test behavioral treatments in IBS patients. It is the largest IBS clinical trial conducted to date and one of the largest behavioral trials ever funded by the NIH without a drug component. Developed at UB, these treatments are regarded as some of the most powerful treatments available to IBS sufferers.

Lackner is currently recruiting IBS patients for the behavioral and imaging studies at the Behavioral Medicine Clinic of the UB Department of Medicine at Erie County Medical Center. For more information on participating in one of the studies, call 716-898-4458 and leave a name, telephone number and convenient times to be contacted.

IBS is among the most common, disabling and intractable gastrointestinal disorders. Twice as common among women as men, it is estimated to affect between 25 million and 50 million Americans. Symptoms include pain, stomach cramps, bloating, diarrhea and/or constipation.

“We're excited about the possibility of providing the first evidence for biological markers that correlate with treatment-induced symptom changes, and developing a better understanding of the mechanism behind IBS,” says Lackner. “Such cutting-edge translational research is going to help foster individualized, specific treatments for patients."

One treatment developed at UB aims to control symptoms by changing specific thinking patterns and behaviors found to aggravate IBS. Using state-of-the-art brain-imaging methods, UCLA researchers, under the leadership of Emeran Mayer, MD, hope to identify the biological mechanisms underlying their effectiveness. Mayer is a professor of medicine and psychiatry at UCLA, director of the Oppenheimer Center for Neurobiology of Stress and principal investigator of the imaging study.

Scientists believe that IBS symptoms are the result of dysregulation of brain-gut interactions, resulting in abnormal muscle contractions in the gut and heightened sensitivity to painful stimuli.

“Just as faulty wiring between the neural connection of the brain and gut can bring on symptoms, so learning new ways of thinking and behaving may 'rewire' brain-gut interactions, resulting in reduced pain and bowel symptoms that otherwise take a major toll on patients," says Lackner. "Determining whether behavioral treatments work by targeting specific areas of the brain that have a direct effect on gut function and sensation is a major goal of this study.”

Correlating structural brain changes with symptom reduction is, for both Lackner and Mayer, a primary goal that they say will demonstrate an ‘organic’ component to IBS, which is critical. “IBS is often unfairly dismissed as a psychosomatic condition,” says Mayer. “These findings will be important in dispelling the notion once and for all that IBS symptoms are not real and are ‘only psychological.’”

Lackner’s UB’s colleagues on the study include Michael Sitrin, MD, professor; Christopher Radziwon, PhD, research assistant professor; Greg Gudleski, PhD, clinical research assistant professor; Leonard Katz, MD, professor emeritus; and Rebecca Firth, senior research support specialist; all in the Department of Medicine, and Susan Krasner, PhD, clinical assistant professor of anesthesiology.