Mayer E A, Tillisch K, Bradesi S
Department of Medicine, Center for Neurovisceral Sciences and Women's Health, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA.
Aliment Pharmacol Ther. 2006 Sep 15;24(6):919-33. doi: 10.1111/j.1365-2036.2006.03078.x.
The importance of bi-directional brain-gut interactions in gastrointestinal illness is increasingly being recognized, most prominently in the area of functional gastrointestinal disorders. Numerous current and emerging therapies aimed at normalizing brain-gut interactions are a focus of interest, particularly for irritable bowel syndrome and functional dyspepsia.
A literature search was completed for preclinical and clinical studies related to central modulation of gastrointestinal functions and published in English between 1980 and 2006.
Existing data, while sparse, support the use of different classes of antidepressant drugs, including tricyclics, and selective and non-selective serotonin reuptake inhibitors in irritable bowel syndrome. Serotonin receptor agonists and antagonists with peripheral and possibly central effects are effective in treating specific subtypes of irritable bowel syndrome. Based largely on theoretical and preclinical evidence, several novel compounds that selectively target receptors at multiple levels within the brain-gut axis such as neurokinin, somatostatin and corticotropin-releasing factor receptor antagonists are promising.
This review discusses the rationale for modulation of the brain-gut axis in the treatment of functional gastrointestinal disorders and highlights the most promising current and future therapeutic strategies.
脑-肠双向相互作用在胃肠道疾病中的重要性日益受到认可，在功能性胃肠疾病领域最为显著。目前许多旨在使脑-肠相互作用正常化的现有及新兴疗法成为关注焦点，尤其是对肠易激综合征和功能性消化不良而言。
完成了一项针对1980年至2006年间以英文发表的与胃肠道功能中枢调节相关的临床前和临床研究的文献检索。
现有数据虽稀少，但支持在肠易激综合征中使用不同类别的抗抑郁药物，包括三环类药物以及选择性和非选择性5-羟色胺再摄取抑制剂。具有外周及可能中枢作用的5-羟色胺受体激动剂和拮抗剂在治疗肠易激综合征的特定亚型方面有效。主要基于理论和临床前证据，几种选择性靶向脑-肠轴内多个水平受体的新型化合物，如神经激肽、生长抑素和促肾上腺皮质激素释放因子受体拮抗剂，前景广阔。
本综述讨论了调节脑-肠轴治疗功能性胃肠疾病的基本原理，并重点介绍了当前和未来最有前景的治疗策略。
