Abnormal Resting Brain Activity Of Default Mode Network In Gastroesophageal Reflux Disease:A Pilot Study

PurposeIn order to evaluate the pathological mechanism of brain dysfunction by analyzing the brain activity characteristic in gastroesophageal reflux disease(GERD)patients under resting state,and explore its relationship with Gastrointestinal Symptom Rating Scale(GSRS)scores,the Zung Self-Rating Depression Scale(SDS)and the Zung Self-Rating Anxiety Scale(SAS).Materials and Methods30 GERD patients who visited Zhujiang hospital gastroenterology department between September 2016 and December 2017 were accepted for this study.Another 49 persons with similar age and sex were chosen as healthy control subjects.All subjects underwent MRI scan,and Gastrointestinal Symptom Rating Scale(GSRS)scores,the Zung Self-Rating Depression Scale(SDS)and the Zung Self-Rating Anxiety Scale(SAS)was adopted in GERD before the scan.The MRI scanning sequences include conventional and resting-state functional magnetic imaging(RS-fMRI).The regional homogeneity(ReHo)andfractional amplitude of low-frequency fluctuation(fALFF)were analyzed and compared between the GERD and control group,and explore relationship between its abnormal brain activities with GSRS scores values,the SDS values and the SAS values.Results(1)The GSRS values,SDS values and SAS values of the GERD group was more effective than the control group,and reveal that the gastrointestinal symptoms and anxiety depression in GERD group were worse than those in the control group.The GERD group was more effective than the control group in relieving symptoms.The 10 items of SDS,such as depression,easy to cry,sleep disorder,loss of libido,weight loss,difficulty in thinking,loss of ability,anxiety,despair,difficulty in determination,etc.,have statistical significance.And the17 items of SAS,such as anxiety,fear,crazy feeling,unfortunatehunch,body pain,fatigue,akathisia,heart palpitations,dizziness,difficulty breathing,hand and foot tingling,indigestion,frequent urination,sleep disturbances,nightmares,have statistical significance.(2)Significantly increased ReHo values with the DMN in bilateral medial prefrontal cortex,dACC,posterior cingulate gyrus,precuneus and angular gyrus,and decreased ReHo values in bilateral superior temporal gyrus,middle temporal gyrus,rostral anterior cingulate cortex(rACC).Meanwhile,negative correlation was observed between ReHo value and disease course in the superior temporal gyrus.(3)Compared with healthy subjects,GERD patients show significantly increased fALFF values with the DMN in bilateral dorsal anterior cingulate cortex(dACC)and precuneus,and decreased fALFF values in the paracentral lobule.Negative correlation was observed between fALFF value and GSRS scores,SDS scores,SAS scores in the paracentral lobule.Meanwhile,negative correlation was observed between ReHo value and disease course in the paracentral lobule and dACC.(4)Use both ReHo and fALFF for conjunction analyses showing the overlap activated brain regions ofin the precuneus.Conclusion(1)In addition to typical gastroesophageal reflux symptoms,GERD patients have symptoms of irritable bowel syndrome;(2)Patients with GERD have bad mood or mental disorder such as anxiety and depression;(3)The default network is an important brain network that is sensitive and active in human brain when resting state.Compared with the healthy control group,the activity of the default network of GERD was significantly different from that of the control group,and occurred a series of dysfunction changes.Some of these brain regions are closely related to the severity and psychology of symptoms.This change may be related to the pathologic basis of the disease,which helps to further understand the prognosis of GERD treatment from the level of neural activity.Whether precuneus are only abnormalareas or just more sensitive than other regions of DMNin GERD remains to be elucidated.