Share：
Share this content in WeChat
X
[Chinese] [PDF] 72 2
• Clinical Article •
Regulatory effect of gut-targeted therapy on brain function and emotional changes in patients with diarrhea-predominant irritable bowel syndrome: A resting-state fMRI study
ZHAO Yuxin  WANG Man  WU Hailin  LIU Zongxin  ZHANG Qianyu  LEI Xiaoyan  ZONG Wei 

Cite this article as: ZHAO Y X, WANG M, WU H L, et al. Regulatory effect of gut-targeted therapy on brain function and emotional changes in patients with diarrhea-predominant irritable bowel syndrome: A resting-state fMRI study[J]. Chin J Magn Reson Imaging, 2025, 16(7): 1-5, 46. DOI:10.12015/issn.1674-8034.2025.07.001.


[Abstract] Objective To investigate changes in brain functional activity before and after gut-targeted therapy in patients with diarrhea-predominant irritable bowel syndrome (IBS-D) using resting-state functional magnetic resonance imaging (rs-fMRI), and to explore the underlying gut-brain regulatory mechanisms.Materials and Methods Thirty newly diagnosed IBS-D patients (meeting Rome Ⅳ criteria) were prospectively enrolled. Baseline assessments included the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Pittsburgh Sleep Quality Index (PSQI), followed by rs-fMRI scanning. After 30 days of standardized gut-targeted therapy, all scales and imaging were repeated. Paired sample t-tests were used to compare differences in z-score standardized amplitude of low-frequency fluctuation (zALFF) and z-score standardized regional homogeneity (zReHo) pre- and post-treatment. Correction was carried out using the Gaussian random field (GRF). Spearman correlation analysis was performed between functional indices's changes of altered brain regions and scale scores's changes.Results Compared with before treatment, the IBS-SSS (P < 0.001), HAMA (P = 0.004), HAMD (P = 0.026) and PSQI (P = 0.007) scores of IBS-D patients decreased significantly after intestinal targeted therapy. Decreased zALFF values in the cuneus, precuneus and calcarine fissure and surrounding cortex (GRF correction, voxel-level P < 0.005, cluster-level P < 0.05). Significant reductions in zReHo values in the cuneus, precuneus, and superior occipital gyrus (GRF correction, voxel-level P < 0.005, cluster-level P < 0.05). A significant positive correlation between changes in precuneus zALFF and the scores of the pain anxiety in HAMA (r = 0.405, P = 0.027), and between precuneus zReHo changes and the depression scores in HAMD (r = 0.498, P = 0.005).Conclusions Gut-targeted therapy in IBS-D patients improved intestinal symptoms, anxiety, depression and sleep quality, accompanied by reduced activity in the precuneus and cuneus. The decreased functional activity in the precuneus may underlie the alleviation of anxiety and depressive symptoms.
[Keywords] resting-state functional magnetic resonance imaging；diarrhea-predominant irritable bowel syndrome；amplitude of low-frequency fluctuation；regional homogeneity；gut-targeted therapy；magnetic resonance imaging

ZHAO Yuxin1   WANG Man2   WU Hailin1   LIU Zongxin3   ZHANG Qianyu3   LEI Xiaoyan2   ZONG Wei4*  

1 Department of Medical Equipment, Shaanxi Provincial People's Hospital, Xi'an 710068, China

2 Department of MRI, Shaanxi Provincial People's Hospital, Xi'an 710068, China

3 The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, China

4 First Department of Digestive System, Shaanxi Provincial People's Hospital, Xi'an 710068, China

Corresponding author: ZONG W, E-mail: zongweidoctor@163.com

Conflicts of interest   None.

Received  2025-03-23
Accepted  2025-07-04
DOI: 10.12015/issn.1674-8034.2025.07.001
Cite this article as: ZHAO Y X, WANG M, WU H L, et al. Regulatory effect of gut-targeted therapy on brain function and emotional changes in patients with diarrhea-predominant irritable bowel syndrome: A resting-state fMRI study[J]. Chin J Magn Reson Imaging, 2025, 16(7): 1-5, 46. DOI:10.12015/issn.1674-8034.2025.07.001.

[1]
WANG F, LIU Y L, JIANG C H, et al. Association between psychiatric disorders and irritable bowel syndrome: a bidirectional Mendelian randomization study[J]. J Affect Disord, 2025, 368: 865-871. DOI: 10.1016/j.jad.2024.09.030.
[2]
SEBASTIÁN DOMINGO J J. Irritable bowel syndrome[J]. Med Clínica Engl Ed, 2022, 158(2): 76-81. DOI: 10.1016/j.medcli.2021.04.029.
[3]
FRISSORA C L, SCHILLER L R. Getting the BS out of irritable bowel syndrome with diarrhea (IBS-D): let's make a diagnosis[J]. Curr Gastroenterol Rep, 2024, 26(1): 20-29. DOI: 10.1007/s11894-023-00909-1.
[4]
OKA P, PARR H, BARBERIO B, et al. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2020, 5(10): 908-917. DOI: 10.1016/S2468-1253(20)30217-X.
[5]
SARNOFF R P, BHATT R R, OSADCHIY V, et al. A multi-omic brain gut microbiome signature differs between IBS subjects with different bowel habits[J/OL]. Neuropharmacology, 2023, 225: 109381 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/36539012/. DOI: 10.1016/j.neuropharm.2022.109381.
[6]
TARAR Z I, FAROOQ U, ZAFAR Y, et al. Burden of anxiety and depression among hospitalized patients with irritable bowel syndrome: a nationwide analysis[J]. Ir J Med Sci, 2023, 192(5): 2159-2166. DOI: 10.1007/s11845-022-03258-6.
[7]
ALTOMARE A, DI ROSA C, IMPERIA E, et al. Diarrhea predominant-irritable bowel syndrome (IBS-D): effects of different nutritional patterns on intestinal dysbiosis and symptoms[J/OL]. Nutrients, 2021, 13(5): 1506 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/33946961/. DOI: 10.3390/nu13051506.
[8]
YUAN Y, WANG X Y, HUANG S, et al. Low-level inflammation, immunity, and brain-gut axis in IBS: unraveling the complex relationships[J/OL]. Gut Microbes, 2023, 15(2): 2263209 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/37786296/. DOI: 10.1080/19490976.2023.2263209.
[9]
DIAO Z H, XU W C, GUO D Y, et al. Causal association between psycho-psychological factors, such as stress, anxiety, depression, and irritable bowel syndrome: Mendelian randomization[J/OL]. Medicine (Baltimore), 2023, 102(34): e34802 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/37653741/. DOI: 10.1097/MD.0000000000034802.
[10]
JAYASINGHE M, DAMIANOS J A, PRATHIRAJA O, et al. Irritable bowel syndrome: treating the gut and brain/mind at the same time[J/OL]. Cureus, 2023, 15(8): e43404 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/37706135/. DOI: 10.7759/cureus.43404.
[11]
HANNA-JAIRALA I, DROSSMAN D A. Central neuromodulators in irritable bowel syndrome: why, how, and when[J]. Am J Gastroenterol, 2024, 119(7): 1272-1284. DOI: 10.14309/ajg.0000000000002800.
[12]
AO W Q, CHENG Y G, CHEN M X, et al. Intrinsic brain abnormalities of irritable bowel syndrome with diarrhea: a preliminary resting-state functional magnetic resonance imaging study[J/OL]. BMC Med Imaging, 2021, 21(1): 4 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/33407222/. DOI: 10.1186/s12880-020-00541-9.
[13]
SEMINOWICZ D A, LABUS J S, BUELLER J A, et al. Regional gray matter density changes in brains of patients with irritable bowel syndrome[J/OL]. Gastroenterology, 2010, 139(1): 48-57.e2 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/20347816/. DOI: 10.1053/j.gastro.2010.03.049.
[14]
HUANG K Y, HU J Y, LV M, et al. Cerebral cortex changes in FD, IBS, and GERD: a mendelian randomization study[J/OL]. J Affect Disord, 2025, 369: 1153-1160 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/39447977/. DOI: 10.1016/j.jad.2024.10.057.
[15]
QI R F, LIU C, KE J, et al. Intrinsic brain abnormalities in irritable bowel syndrome and effect of anxiety and depression[J]. Brain Imaging Behav, 2016, 10(4): 1127-1134. DOI: 10.1007/s11682-015-9478-1.
[16]
ZHENG L, LAI Y L, LU W M, et al. Pinaverium reduces symptoms of irritable bowel syndrome in a multicenter, randomized, controlled trial[J/OL]. Clin Gastroenterol Hepatol, 2015, 13(7): 1285-1292.e1 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/25632806/. DOI: 10.1016/j.cgh.2015.01.015.
[17]
BOR S, LEHERT P, CHALBAUD A, et al. Efficacy of pinaverium bromide in the treatment of irritable bowel syndrome: a systematic review and meta-analysis[J/OL]. Therap Adv Gastroenterol, 2021, 14: 17562848211033740 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/34539813/. DOI: 10.1177/17562848211033740.
[18]
Chinese Society of Gastroenterology, Functional Gastrointestinal Disease Collaboration Group. Chinese expert consensus of irritable bowel syndrome in 2020[J]. Chin J Dig, 2020, 40(12): 803-818. DOI: 10.3760/cma.j.cn311367-20201116-00660.
[19]
BOWERS H, WROE A. Beliefs about emotions mediate the relationship between emotional suppression and quality of life in irritable bowel syndrome[J]. J Ment Health, 2016, 25(2): 154-158. DOI: 10.3109/09638237.2015.1101414.
[20]
MADVA E N, SADLONOVA M, HARNEDY L E, et al. Positive psychological well-being and clinical characteristics in IBS: a systematic review[J/OL]. Gen Hosp Psychiatry, 2023, 81: 1-14 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/36681019/. DOI: 10.1016/j.genhosppsych.2023.01.004.
[21]
MAYER E A, RYU H J, BHATT R R. The neurobiology of irritable bowel syndrome[J]. Mol Psychiatry, 2023, 28(4): 1451-1465. DOI: 10.1038/s41380-023-01972-w.
[22]
HILLESTAD E M R, VAN DER MEEREN A, NAGARAJA B H, et al. Gut bless you: The microbiota-gut-brain axis in irritable bowel syndrome[J]. World J Gastroenterol, 2022, 28(4): 412-431. DOI: 10.3748/wjg.v28.i4.412.
[23]
DADARIO N B, SUGHRUE M E. The functional role of the precuneus[J]. Brain, 2023, 146(9): 3598-3607. DOI: 10.1093/brain/awad181.
[24]
CHEN X F, GUO Y, LU X Q, et al. Aberrant intraregional brain activity and functional connectivity in patients with diarrhea-predominant irritable bowel syndrome[J/OL]. Front Neurosci, 2021, 15: 721822 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/34539337/. DOI: 10.3389/fnins.2021.721822.
[25]
WANG L, LUO X Y, QING X L, et al. Symptom effects and central mechanism of acupuncture in patients with functional gastrointestinal disorders: a systematic review based on fMRI studies[J/OL]. BMC Gastroenterol, 2024, 24(1): 47 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/38267863/. DOI: 10.1186/s12876-024-03124-y.
[26]
KANO M, MURATSUBAKI T, MORISHITA J, et al. Influence of uncertain anticipation on brain responses to aversive rectal distension in patients with irritable bowel syndrome[J]. Psychosom Med, 2017, 79(9): 988-999. DOI: 10.1097/PSY.0000000000000484.
[27]
OŚWIĘCIMSKA J, SZYMLAK A, ROCZNIAK W, et al. New insights into the pathogenesis and treatment of irritable bowel syndrome[J]. Adv Med Sci, 2017, 62(1): 17-30. DOI: 10.1016/j.advms.2016.11.001.
[28]
LIU M, YE Z, WU Q, et al. Healthy sleep, mental health, genetic susceptibility, and risk of irritable bowel syndrome[J/OL]. J Affect Disord, 2023, 331: 25-32 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/36934852/. DOI: 10.1016/j.jad.2023.03.033.
[29]
QI R, LIU C, KE J, et al. Abnormal amygdala resting-state functional connectivity in irritable bowel syndrome[J]. AJNR Am J Neuroradiol, 2016, 37(6): 1139-1145. DOI: 10.3174/ajnr.A4655.
[30]
POP D, MAN S C, FARCĂU D. Anxiety and depression in children with irritable bowel syndrome-a narrative review[J/OL]. Diagnostics (Basel), 2025, 15(4): 433 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/40002584/. DOI: 10.3390/diagnostics15040433.
[31]
DÉCARIE-SPAIN L, HAYES A M R, LAUER L T, et al. The gut-brain axis and cognitive control: a role for the vagus nerve[J]. Semin Cell Dev Biol, 2024, 156: 201-209. DOI: 10.1016/j.semcdb.2023.02.004.
[32]
GOODOORY V C, KHASAWNEH M, THAKUR E R, et al. Effect of brain-gut behavioral treatments on abdominal pain in irritable bowel syndrome: systematic review and network meta-analysis[J/OL]. Gastroenterology, 2024, 167(5): 934-943.e5 [2025-03-22]. https://pubmed.ncbi.nlm.nih.gov/38777133/. DOI: 10.1053/j.gastro.2024.05.010.

PREV Correction to: Predictive value of ADCmean combined with PSAD in clinically significant prostate cancer with PI-RADS score ≥ 3
NEXT Research on autism brain function network and gradient feature classification based on ensemble learning
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn