Center for Neurobiology of Stress, Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Annu Rev Med. 2011;62:381-96. doi: 10.1146/annurev-med-012309-103958.
The importance of bidirectional brain-gut interactions in gastrointestinal (GI) illness is increasingly recognized, most prominently in the area of functional GI syndromes such as irritable bowel syndrome (IBS), functional dyspepsia, and functional chest pain. The brain receives a constant stream of interoceptive input from the GI tract, integrates this information with other interoceptive information from the body and with contextual information from the environment, and sends an integrated response back to various target cells within the GI tract. This system is optimized to assure homeostasis of the GI tract during physiological perturbations and to adapt GI function to the overall state of the organism. In health, the great majority of interoceptive information reaching the brain is not consciously perceived but serves primarily as input to autonomic reflex pathways. In patients with functional abdominal pain syndromes, conscious perception of interoceptive information from the GI tract, or recall of interoceptive memories of such input, can occur in the form of constant or recurrent discomfort or pain. This is often associated with alterations in autonomic nervous system output and with emotional changes. A model is proposed that incorporates reported peripheral and central abnormalities in patients with IBS, extrapolates similar alterations in brain-gut interactions to patients with other chronic abdominal pain syndromes, and provides novel treatment targets.
双向的脑-肠相互作用在胃肠道（GI）疾病中的重要性日益受到重视，在功能性 GI 综合征领域尤为明显，如肠易激综合征（IBS）、功能性消化不良和功能性胸痛。大脑从胃肠道接收源源不断的内脏传入信息，将这些信息与来自身体的其他内脏信息以及来自环境的上下文信息整合，并将综合反应发送回胃肠道内的各种靶细胞。该系统旨在确保胃肠道在生理波动期间的内稳态，并使 GI 功能适应机体的整体状态。在健康状态下，到达大脑的绝大多数内脏传入信息并未被有意识地感知，但主要作为自主反射途径的输入。在功能性腹痛综合征患者中，对来自胃肠道的内脏传入信息的有意识感知，或对这种传入的内脏记忆的回忆，可能表现为持续或反复的不适或疼痛。这通常与自主神经系统输出的改变和情绪变化有关。提出了一个模型，该模型纳入了 IBS 患者报告的外周和中枢异常，推断出其他慢性腹痛综合征患者脑-肠相互作用的类似改变，并提供了新的治疗靶点。
