Slim Mahmoud, Calandre Elena Pita, Rico-Villademoros Fernando
Instituto de Neurociencias "Federico Olóriz", Universidad de Granada, Avenida de Madrid, 11., 18012, Granada, Spain.
Rheumatol Int. 2015 Mar;35(3):433-44. doi: 10.1007/s00296-014-3109-9. Epub 2014 Aug 14.
Fibromyalgia syndrome is characterized by chronic generalized pain accompanied by a broad symptomatologic spectrum. Besides chronic fatigue, sleep disturbances, headaches and cognitive dysfunction that are extensively described in the literature, a considerable proportion of patients with fibromyalgia experience gastrointestinal symptoms that are commonly overlooked in the studies that are not specifically dedicated to evaluate these manifestations. Nevertheless, various attempts were undertaken to explore the gastrointestinal dimension of fibromyalgia. Several studies have demonstrated an elevated comorbidity of irritable bowel syndrome (IBS) among patients with fibromyalgia. Other studies have investigated the frequency of presentation of gastrointestinal symptoms in fibromyalgia in a nonspecific approach describing several gastrointestinal complaints frequently reported by these patients such as abdominal pain, dyspepsia and bowel changes, among others. Several underlying mechanisms that require further investigation could serve as potential explanatory hypotheses for the appearance of such manifestations. These include sensitivity to dietary constituents such as gluten, lactose or FODMAPs or alterations in the brain-gut axis as a result of small intestinal bacterial overgrowth or subclinical enteric infections such as giardiasis. The gastrointestinal component of fibromyalgia constitutes a relevant element of the multidisciplinary pathophysiologic mechanisms underlying fibromyalgia that need to be unveiled, as this would contribute to the adequate designation of relevant treatment alternatives corresponding to these manifestations.
纤维肌痛综合征的特征是慢性广泛性疼痛，并伴有广泛的症状谱。除了文献中广泛描述的慢性疲劳、睡眠障碍、头痛和认知功能障碍外，相当一部分纤维肌痛患者还会出现胃肠道症状，而在并非专门评估这些表现的研究中，这些症状通常被忽视。尽管如此，人们还是进行了各种尝试来探索纤维肌痛的胃肠道方面。几项研究表明，纤维肌痛患者中肠易激综合征（IBS）的共病率升高。其他研究则以非特异性方法调查了纤维肌痛患者胃肠道症状的出现频率，描述了这些患者经常报告的几种胃肠道不适，如腹痛、消化不良和肠道改变等。一些需要进一步研究的潜在机制可以作为这些表现出现的潜在解释性假设。这些机制包括对饮食成分如麸质、乳糖或可发酵寡糖、双糖、单糖和多元醇（FODMAPs）的敏感性，或由于小肠细菌过度生长或亚临床肠道感染如贾第虫病导致的脑-肠轴改变。纤维肌痛的胃肠道成分是纤维肌痛潜在的多学科病理生理机制的一个相关要素，需要揭示，因为这将有助于为对应于这些表现的相关治疗选择进行适当的指定。
