Irritable Bowel Syndrome : tudies of central pathophysiological mechanisms and effects of treatment

..................................................................................................................................... 1 Populärvetenskaplig sammanfattning ....................................................................................... 2 List of papers .............................................................................................................................. 4 Abbreviations ............................................................................................................................. 5 Introduction ................................................................................................................................ 6 Irritable Bowel Syndrome ....................................................................................................... 6 Hypnotherapy in the treatment of IBS ................................................................................... 7 Educational interventions in IBS ............................................................................................. 8 Brain imaging .......................................................................................................................... 8 Central aspects of visceral sensation.................................................................................... 11 Aims .......................................................................................................................................... 17 Methods ................................................................................................................................... 18 Subjects ................................................................................................................................. 18 Questionnaires...................................................................................................................... 20 Hypnotherapy ....................................................................................................................... 21 Educational intervention ...................................................................................................... 21 fMRI experimental protocol ................................................................................................. 21 Determination of perception thresholds ............................................................................. 22 Expectation and visceral stimuli fMRI paradigm .................................................................. 23 fMRI data acquisition ............................................................................................................ 24 fMRI data analysis ................................................................................................................. 24 Ethical approval .................................................................................................................... 26 Results ...................................................................................................................................... 27 Classification of visceral sensitivity and clinical characterization of IBS patients ................ 27 Brain responses to rectal distension and expectation of rectal distension ......................... 29 Behavioral responses to treatment ...................................................................................... 37 Brain responses to successful treatment ............................................................................. 37 General Discussion ................................................................................................................... 42 Conclusions ............................................................................................................................... 46 Methodological considerations ................................................................................................ 47 Future directions ...................................................................................................................... 48 Acknowledgements .................................................................................................................. 50 References ................................................................................................................................ 52 Errata ........................................................................................................................................ 62