Psychophysiology of the Gastrointestinal Tract

I Esophagus.- 1 Studies of Esophageal Function during Waking and Sleep.- 1. Introduction.- 2. Tests of Esophageal Function.- 2.1. Esophageal Motility.- 2.2. Clinical Tests of Acid Clearance.- 2.3. Esophageal pH Monitoring.- 3. Esophageal Function during Sleep.- 4. Implications and Future Studies.- 5. References.- 2 The Responsiveness of the Esophagus to Environmental Stimuli.- 1. Introduction.- 2. Types of Esophageal Motility.- 3. Relation of Tertiary Contractions to Psychological Stress.- 4. Experimental Studies of Acoustically Induced Esophageal Contractions.- 4.1. Intensity of Stimuli Required to Produce Contractions.- 4.2. Orienting versus Defense Reactions.- 5. Implications for Understanding and Treatment of Esophageal Motor Disorders.- 6. References.- 3 Disorders of the Esophagus: Applications of Psychophysiological Methods to Treatment.- 1. Introduction.- 2. Disorders of the Esophagus.- 2.1. Globus Hystericus.- 2.2. Diffuse Esophageal Spasm.- 2.3. Reflux Esophagitis.- 2.4. Achalasia.- 3. Physiology of the Lower Esophageal Sphincter.- 3.1. Reflex Motor Responses.- 3.2. Pharmacology of the LES.- 4. Biofeedback Training to Raise Lower Esophageal Sphincter Pressure.- 5. References.- 4 Psychological Treatment Approaches to Psychogenic Vomiting and Rumination.- 1. Introduction.- 2. Clinical Syndrome.- 2.1. Topography.- 2.2. Etiology.- 2.3. Clinical Consequences.- 3. Treatment Approaches.- 3.1. Medical Interventions.- 3.2. Massive Attention.- 3.3. Psychotherapy.- 3.4. Peripheral Electric Shock Therapy.- 3.5. Taste Aversion Methods.- 3.6. Differential Reinforcement and Other Behavioral Techniques.- 4. Comparison of Treatment Approaches.- 5. Conclusions.- 6. References.- II Stomach.- 5 Surface Gastrograms as Measures of Gastric Motility.- 1. Introduction: A Short History of Gastric Motility Records.- 2. Electromotor Activity of the Stomach.- 2.1. The Role of Indices of Electromotor Activity.- 2.2. Contractile Activity of the Stomach.- 2.3. Electrical Activity of the Stomach.- 3. Signal Parameters of Gastric Activity and Their Psychophysiological Information Content.- 4. Electrical Recordings from the Abdominal Surface: Current Practice in Psychophysiology.- 4.1. Apparatus and Procedures: Overview.- 4.2. Recording Sites.- 4.3. Signal Analysis.- 4.4. Validity of Electrogastrograms—Critical Evaluation.- 5. Magnetogastrography.- 5.1. Classical Methods.- 5.2. Three-Axes Magnetogastrogram with Freely Moving Magnet.- 5.3. Magnetogastrographies with Ferromagnetic Tracer Material.- 5.4. Signal Analysis.- 6. Conclusion.- 7. References.- 6 Conjoint Gastrography: Principles and Techniques.- 1. Introduction.- 2. Rationale of Conjoint Gastrography.- 3. Electrogastrograms.- 3.1. Recording Sites.- 3.2. Electrodes and Skin Preparation.- 3.3. Amplifiers and Filters.- 4. Magnetogastrograms.- 4.1. Magnetometers and Magnetic Capsules.- 4.2. Amplifiers and Filters.- 4.3. Procedure.- 4.4. Procedure with Ferrite Test Meal.- 5. General Procedure and Control Measurements.- 6. Data Acquisition.- 6.1. Laboratory Configuration.- 6.2. Portable Data Logging.- 7. Signal Analysis.- 7.1. Overview.- 7.2. Principles of Fourier Analysis in Gastrography.- 7.3. Basic Fourier Mathematics.- 7.4. Auto- and Cross-spectral Analyses of Conjoint Gastrograms.- 7.5. Evaluation of Spectra.- 8. Selected Results.- 8.1. Peak Histograms.- 8.2. Cross-Correlograms.- 8.3. Coherence Functions.- 9. References.- 7 Measurement of Gastric Acid Secretion.- 1. Introduction.- 2. Measurement of Gastric Acid.- 2.1. The pH Method.- 2.2. The pH Meter-Titration Method.- 2.3. Titration with Chemical Indicators.- 3. Tests of Gastric Secretory Function.- 3.1. Basal Acid Output (BAO).- 3.2. Peak Acid Output (PAO), Maximal Acid Output (MAO), and Calculated Maximal Acid Output (CMAO).- 4. Psychophysiological Measures of Gastric Acid.- 4.1. Intragastric Measures.- 4.2. External Measurement of Gastric Acid.- 5. Subject Considerations in Gastric Research.- 5.1. Subject Selection.- 5.2. Subject Preparation.- 5.3. Intubation Procedure.- 6. References.- 8 Telemetric and Isotope Methods of Measuring Gastric Acid Secretion, Motility, and Emptying.- 1. Measurement of Gastric Acid Secretion by Intragastric Titration and a Telemetering pH Sensor.- 2. Measurement of Intragastric Pressures by Means of a Telemetering Capsule.- 3. Measurement of Gastric Motility and Emptying by a Radioisotope Technique.- 4. References.- 9 Responsiveness of the Stomach to Environmental Events.- 1. Introduction.- 2. Causes for Inadequate Information about Stomach Responsiveness.- 2.1. Unreliability of Subjective Reports.- 2.2. Difficulties with All Known Recording Techniques.- 2.3. Confounding by Digestive Functions.- 2.4. Confounding by Spontaneous Activity.- 3. Passive Responding to External Situations.- 3.1. Temperature.- 3.2. Tones and Lights.- 3.3. Fear, Anger, and Other Emotional States.- 4. Active Responding to External Stimuli.- 4.1. Exercise.- 4.2. Mental Arithmetic.- 4.3. Stress and Ulceration.- 5. Summary and Conclusions.- 6. References.- 10 Treating Stomach Disorders: Can We Reinstate Regulatory Processes?.- 1. Introduction.- 2. Structure, Function, and Disorders of the Stomach.- 3. Regulation.- 3.1. The Role of Efferent Activity in Regulation.- 3.2. The Role of Afferent Activity in Regulation.- 4. Disregulation of the Stomach.- 5. Reinstating Regulatory Processes.- 5.1. The Medical Approach to Treating Stomach Disorders.- 5.2. The Psychoanalytic Approach to Treating Stomach Disorders.- 5.3. The Psychobiological Approach to Treating Stomach Disorders.- 5.4. Biofeedback and Gastric Activity.- 6. Summary.- 7. References.- III Colon.- 11 The Measurement of Colon Motility.- 1. Introduction.- 2. Measurement of the Segmenting Contractions of the Distal Colon.- 2.1. Concept of Paradoxical Motility.- 2.2. Recording Techniques.- 2.3. Stimulation Techniques.- 2.4. Quantification Techniques.- 3. Assessment of Compliance of the Bowel Wall.- 4. Assessment of Evacuation.- 5. References.- 12 Measurement of Electrical Activity of the Colon in Man.- 1. Introduction.- 2. Methods.- 2.1. In Vivo.- 2.2. In Vitro.- 3. Normal Electrical Patterns in Vivo.- 3.1. Slow Waves.- 3.2. Fast Activity.- 4. Normal Electrical Patterns in Vitro.- 4.1. Longitudinal Muscle.- 4.2. Circular Muscle.- 5. Abnormal Electrical Patterns.- 5.1. Diverticular Disease.- 5.2. Irritable Bowel Syndrome.- 5.3. Other Functional Disorders.- 6. Summary.- 7. References.- 13 Colonic Psychophysiology: Implications for Functional Bowel Disorders.- 1. Introduction.- 1.1. Early Observations on Gastrointestinal Responsiveness.- 1.2. Early Observations on Colonic Responsiveness.- 2. Colonie Psychophysiology.- 2.1. Pioneering Experiments.- 2.2. Hyper- versus Hypomotor Responsiveness.- 3. Implications for Functional Bowel Disorders.- 3.1. Five Hypotheses.- 3.2. Abnormal Colonie Responsiveness Hypothesis.- 3.3. Abnormal Stimulation Hypothesis.- 3.4. Abnormal Interoception Hypothesis.- 3.5. Illness Behavior Hypothesis.- 3.6. Heterogeneity Hypothesis.- 3.7. Treatment Implications.- 4. Conclusion.- 5. References.- 14 Irritable Bowel Syndrome: Applications of Psychophysiological Methods to Treatment.- 1. Introduction.- 2. Diagnostic Criteria for Irritable Bowel Syndrome.- 3. Psychophysiology of Irritable Bowel Syndrome.- 3.1. Effects of Meals.- 3.2. Psychological Characteristics of Patients with Irritable Bowel Syndrome.- 3.3. Pain from Gas.- 4. Fiber in the Treatment of Functional Bowel Disorders.- 5. Biofeedback Training to Decrease Colonic Motility.- 6. References.- IV Anal Canal and Rectum.- 15 Fecal Incontinence and Encopresis: A Psychophysiological Analysis.- 1. Introduction.- 2. Diagnosis.- 3. Analysis of Mechanism.- 4. Intervention.- 5. References.- 16 Manometric and Electromyographic Techniques for Assessment of the Anorectal Mechanism for Continence and Defecation.- 1. Introduction.- 2. Anatomy and Physiology.- 3. Measurement Techniques.- 3.1. External Anal Sphincter Contraction.- 3.2. Sensibility for Rectal Distension.- 3.3. Internal Anal Sphincter.- 4. Applications of Psychophysiological Methods to Treatment of Incontinence.- 5. References.- V Interoception.- 17 Interoception: Awareness of Sensations Arising in the Gastrointestinal Tract.- 1. Introduction.- 2. Methods of Investigating Visceral Perception.- 2.1. Method of Limits.- 2.2. Signal Detection Analysis.- 2.3. Forced Choice Procedure.- 2.4. Confounding of Perception and Control.- 2.5. Discrimination Training.- 3. Behavioral Significance of Visceral Perception.- 3.1. Cuing Function in Bowel Control.- 3.2. Hunger and Satiety.- 3.3. Labeling of Emotions.- 3.4. Acquisition and Retention of Voluntary Control over a Visceral Response.- 3.5. Psychosomatic Etiology.- 4. Summary and Conclusions.- 5. References.- 18 Intestinal Afferent Influence on Behavior.- 1. Introduction.- 2. Research Strategies.- 3. Subjective Detection of Gastrointestinal Stimuli.- 4. Effects of Stimulus Intensity and Site of Stimulation.- 5. References.