Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1018
Peer-review started: August 28, 2016
First decision: October 10, 2016
Revised: November 14, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: February 14, 2017
To evaluate brain involvement in quiescent Crohn’s disease (CD) patients with fatigue using quantitative magnetic resonance imaging (MRI).
Multiple MRI techniques were used to assess cerebral changes in 20 quiescent CD patients with fatigue (defined with at least 6 points out of an 11-point numeric rating scale compared with 17 healthy age and gender matched controls without fatigue. Furthermore, mental status was assessed by cognitive functioning, based on the neuropsychological inventory including the different domains global cognitive functioning, memory and executive functioning and in addition mood and quality of life scores. Cognitive functioning and mood status were correlated with MRI findings in the both study groups.
Reduced glutamate + glutamine (Glx = Glu + Gln) concentrations (P = 0.02) and ratios to total creatine (P = 0.02) were found in CD patients compared with controls. Significant increased Cerebral Blood Flow (P = 0.05) was found in CD patients (53.08 ± 6.14 mL/100 g/min) compared with controls (47.60 ± 8.62 mL/100 g/min). CD patients encountered significantly more depressive symptoms (P < 0.001). Cognitive functioning scores related to memory (P = 0.007) and executive functioning (P = 0.02) were lower in CD patients and both scores showed correlation with depression and anxiety. No correlation was found subcortical volumes between CD patients and controls in the T1-weighted analysis. In addition, no correlation was found between mental status and MRI findings.
This work shows evidence for perfusion, neurochemical and mental differences in the brain of CD patients with fatigue compared with healthy controls.
Core tip: The present study explores perfusion, neurochemical and mental differences in the brain of Crohn’s disease (CD) patients compared with healthy controls. This implies that for a gastroenterologist it is important to focus, besides gastrointestinal symptoms due to inflammation, on the effects of systemic inflammation on the brain and mental status. Knowledge and understanding of these effects in CD patients may help health professionals to set up interventions to maintain CD remission and improve mental status by e.g. psychosocial interventions.