Brierley Stuart
Visceral Pain Group, Centre for Nutrition and Gastrointestinal Diseases, Level 7, South Australian Health and Medical Research Institute (SAHMRI), The University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
Adv Exp Med Biol. 2016;891:75-90. doi: 10.1007/978-3-319-27592-5_9.
The gastrointestinal tract is unique in that it is innervated by several distinct populations of neurons, whose cell bodies are either intrinsic (enteric, viscerofugal) or extrinsic (sympathetic, sensory afferents) to the wall of the gut. We are usually completely unaware of the continuous, complicated orchestra of functions that these neurons conduct. However, for patients with Inflammatory Bowel Disease (IBD) or functional gastrointestinal disorders, such as Functional Dyspepsia (FD) and Irritable Bowel Syndrome (IBS) altered gastrointestinal motility, discomfort and pain are common, debilitating symptoms. Whilst bouts of inflammation underlie the symptoms associated with IBD, over the past few years there is increased pre-clinical and clinical evidence that infection and inflammation are key risk factors for the development of several functional gastrointestinal disorders, in particular IBS. There is a strong correlation between prior exposure to gut infection and symptom occurrence; with the duration and severity of the initial illness the strongest associated risk factors. This review discusses the current body of evidence for neuroplasticity during inflammation and how in many cases fails to reset back to normal, long after healing of the damaged tissues. Recent evidence suggests that the altered expression and function of key ion channels and receptors within extrinsic sensory neurons play fundamental roles in the aberrant pain sensation associated with these gastrointestinal diseases and disorders.
胃肠道的独特之处在于它由几种不同类型的神经元支配,这些神经元的细胞体要么是肠道内在的(肠内的、内脏传出的),要么是肠道壁外的(交感神经、感觉传入神经)。我们通常完全没有意识到这些神经元所进行的持续而复杂的功能协调。然而,对于患有炎症性肠病(IBD)或功能性胃肠疾病的患者,如功能性消化不良(FD)和肠易激综合征(IBS),胃肠道运动改变、不适和疼痛是常见的、使人衰弱的症状。虽然炎症发作是IBD相关症状的基础,但在过去几年中,越来越多的临床前和临床证据表明,感染和炎症是几种功能性胃肠疾病,特别是IBS发生的关键危险因素。既往肠道感染与症状出现之间存在很强的相关性;初始疾病的持续时间和严重程度是最强的相关危险因素。本综述讨论了炎症期间神经可塑性的现有证据,以及在许多情况下,在受损组织愈合很久之后,神经可塑性如何未能恢复正常。最近的证据表明,外在感觉神经元内关键离子通道和受体的表达和功能改变,在与这些胃肠疾病相关的异常疼痛感觉中起重要作用。