Centre for Digestive Diseases, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, London E1 2AD, UK.
Nat Rev Gastroenterol Hepatol. 2013 Apr;10(4):206-18. doi: 10.1038/nrgastro.2013.18. Epub 2013 Feb 12.
Chronic disturbances of gastrointestinal function encompass a wide spectrum of clinical disorders that range from common conditions with mild-to-moderate symptoms to rare diseases characterized by a severe impairment of digestive function, including chronic pain, vomiting, bloating and severe constipation. Patients at the clinically severe end of the spectrum can have profound changes in gut transit and motility. In a subset of these patients, histopathological analyses have revealed abnormalities of the gut innervation, including the enteric nervous system, termed enteric neuropathies. This Review discusses advances in the diagnosis and management of the main clinical entities--achalasia, gastroparesis, intestinal pseudo-obstruction and chronic constipation--that result from enteric neuropathies, including both primary and secondary forms. We focus on the various evident neuropathologies (degenerative and inflammatory) of these disorders and, where possible, present the specific implications of histological diagnosis to contemporary treatment. This knowledge could enable the future development of novel targeted therapeutic approaches.
慢性胃肠功能紊乱包括广泛的临床疾病谱，从症状轻到中度的常见疾病到以严重消化功能障碍为特征的罕见疾病，包括慢性疼痛、呕吐、腹胀和严重便秘。在疾病谱的临床严重端的患者可能存在肠道转运和运动的深刻变化。在这些患者的亚组中，组织病理学分析显示肠道神经支配异常，包括肠神经系统，称为肠神经病。本综述讨论了由肠神经病引起的主要临床实体（贲门失弛缓症、胃轻瘫、假性肠梗阻和慢性便秘）的诊断和治疗进展，包括原发性和继发性形式。我们重点介绍了这些疾病的各种明显神经病理学（退行性和炎症性），并在可能的情况下，将组织学诊断的具体意义呈现给当代治疗。这一知识可能为未来开发新型靶向治疗方法提供依据。
