Mulak Agata, Bonaz Bruno
Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.
Med Sci Monit. 2004 Apr;10(4):RA55-62.
Brain-gut interactions are increasingly recognized as underlying pathomechanisms of functional gastrointestinal disorders. Bi-directional communication between the central nervous system (CNS) and the enteric nervous system (ENS) occurs both in health and disease. Various CNS- and gut-directed stressors stimulate the brain-gut axis. Processes modulating responsiveness to stressors along the brain-gut axis involve neural pathways, the immunological, and endocrinological mechanisms. Disturbances at every level of neural control of the gastrointestinal tract can affect modulation of gastrointestinal motility, secretion, immune functions as well as perception and emotional response to visceral events. ENS function, central processing, and autonomic regulation play an important role in the brain-gut dialogue. Stress and emotions may trigger neuroimmune and neuroendocrine reactions via the brain-gut axis. Various non-site specific neurotransmitters influence gastrointestinal, endocrine and immune function, as well as human behavior and emotional state, depending on their location. The physiology of the digestive tract, the subjective experience of symptom, health behavior, and treatment outcome are strongly affected by psychosocial factors. Recently, a biopsychosocial model of IBS containing physiological, emotional, cognitive and behavioral components has been proposed. Rapid progress in neurogastroenterology, using new brain imaging techniques, should bring better understanding of the brain-gut axis and open new therapeutic perspectives.
脑-肠相互作用日益被认为是功能性胃肠疾病的潜在发病机制。中枢神经系统（CNS）与肠神经系统（ENS）之间的双向通信在健康和疾病状态下均会发生。各种中枢和肠道定向应激源会刺激脑-肠轴。沿脑-肠轴调节对应激源反应性的过程涉及神经通路、免疫和内分泌机制。胃肠道神经控制各个层面的紊乱都会影响胃肠动力、分泌、免疫功能以及对内脏事件的感知和情绪反应的调节。ENS功能、中枢处理和自主调节在脑-肠对话中起重要作用。压力和情绪可能通过脑-肠轴触发神经免疫和神经内分泌反应。各种非位点特异性神经递质根据其位置影响胃肠、内分泌和免疫功能以及人类行为和情绪状态。社会心理因素会强烈影响消化道的生理功能、症状的主观体验、健康行为和治疗结果。最近，一种包含生理、情绪、认知和行为成分的肠易激综合征生物心理社会模型已被提出。利用新的脑成像技术，神经胃肠病学的快速发展应能带来对脑-肠轴更好的理解并开辟新的治疗前景。
