Neurogastroenterology Group, Wingate Institute of Neurogastroenterology, Centre for Gastroenterology, Blizzard Centre for Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
J Psychosom Res. 2010 May;68(5):475-81. doi: 10.1016/j.jpsychores.2009.12.006. Epub 2010 Feb 8.
The growing evidence for a key role of psychophysiological processes in the etiopathogenesis of functional gastrointestinal disorders (FGID) originates from various sources, including epidemiological, psychometric, physiological, and behavioural studies. Functional neuroimaging has improved our knowledge about central processing of visceral pain, a defining feature of FGID. However, results have been disappointingly inconsistent, often due to psychosocial factors not being controlled for. In this paper, we aim to show that using integrated research strategies, encompassing a number of scientific disciplines, is critical to advancing our understanding of FGID. We will illustrate this by describing recent integrative studies that may serve as good examples. More specifically, future FGID neuroimaging studies should control for psychosocial factors and incorporate methods from other branches of neuroscience outside this field, especially cognitive, affective and autonomic neuroscience. We therefore propose a framework for the development of an integrative cross-disciplinary research strategy based on advancing our understanding of visceral nociceptive physiology in health as well as vulnerability and susceptibility factors for FGID. This approach will allow the identification of factors responsible for the inter-individual differences in visceral pain perception and susceptibility to chronic visceral pain, leading to the description of multidimensional (visceral) pain "endophenotypes." These may represent the critical steps needed towards a pathophysiological, rather than symptom-based, classification of FGID, which may be more suitable for genetic association studies. This approach may ultimately culminate in individual tailoring of treatment, in addition to disease prevention, thereby improving outcomes for the patient and researcher alike.
越来越多的证据表明,心理生理过程在功能性胃肠疾病(FGID)的发病机制中起着关键作用,其来源包括流行病学、心理测量学、生理学和行为学研究。功能性神经影像学提高了我们对内脏疼痛中枢处理的认识,内脏疼痛是 FGID 的一个特征。然而,结果令人失望地不一致,这往往是由于没有控制社会心理因素。在本文中,我们旨在表明,使用综合研究策略,包括多个科学学科,对于推进我们对 FGID 的理解至关重要。我们将通过描述最近的综合研究来说明这一点,这些研究可以作为很好的例子。具体来说,未来的 FGID 神经影像学研究应控制社会心理因素,并结合该领域以外的神经科学其他分支的方法,特别是认知、情感和自主神经科学。因此,我们提出了一个基于健康内脏痛觉生理学以及 FGID 的脆弱性和易感性因素的综合跨学科研究策略的发展框架。这种方法将能够确定导致个体间内脏痛觉感知差异和对慢性内脏痛易感性的因素,从而描述多维(内脏)疼痛“内表型”。这些可能代表了向基于病理生理而不是基于症状的 FGID 分类迈出的关键步骤,这可能更适合遗传关联研究。这种方法最终可能导致针对个体的治疗方法,除了疾病预防,从而改善患者和研究人员的结果。
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