Division of Gastroenterology, Oppenheimer Center for Neurobiology of Stress and Resilience at University of California, Los Angeles, California.
Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
Gastroenterology. 2018 Feb;154(3):723-735. doi: 10.1053/j.gastro.2017.12.010. Epub 2017 Dec 27.
In June 2016, the National Institutes of Health hosted a workshop on functional bowel disorders (FBDs), particularly irritable bowel syndrome, with the objective of elucidating gaps in current knowledge and recommending strategies to address these gaps. The workshop aimed to provide a roadmap to help strategically guide research efforts during the next decade. Attendees were a diverse group of internationally recognized leaders in basic and clinical FBD research. This document summarizes the results of their deliberations, including the following general conclusions and recommendations. First, the high prevalence, economic burden, and impact on quality of life associated with FBDs necessitate an urgent need for improved understanding of FBDs. Second, preclinical discoveries are at a point that they can be realistically translated into novel diagnostic tests and treatments. Third, FBDs are broadly accepted as bidirectional disorders of the brain-gut axis, differentially affecting individuals throughout life. Research must integrate each component of the brain-gut axis and the influence of biological sex, early-life stressors, and genetic and epigenetic factors in individual patients. Fourth, research priorities to improve diagnostic and management paradigms include enhancement of the provider-patient relationship, longitudinal studies to identify risk and protective factors of FBDs, identification of biomarkers and endophenotypes in symptom severity and treatment response, and incorporation of emerging "-omics" discoveries. These paradigms can be applied by well-trained clinicians who are familiar with multimodal treatments. Fifth, essential components of a successful program will include the generation of a large, validated, broadly accessible database that is rigorously phenotyped; a parallel, linkable biorepository; dedicated resources to support peer-reviewed, hypothesis-driven research; access to dedicated bioinformatics expertise; and oversight by funding agencies to review priorities, progress, and potential synergies with relevant stakeholders.
2016 年 6 月，美国国立卫生研究院（NIH）主办了一次关于功能性肠病（FBD），特别是肠易激综合征的研讨会，旨在阐明当前知识空白，并提出解决这些空白的策略。该研讨会旨在提供一份路线图，帮助在未来十年内战略性地指导研究工作。与会者是国际公认的基础和临床 FBD 研究的多样化领导者。本文件总结了他们的审议结果，包括以下一般结论和建议。首先，FBD 高发病率、经济负担和对生活质量的影响需要迫切需要更好地了解 FBD。其次，临床前发现已经到了可以将其转化为新的诊断测试和治疗方法的现实阶段。第三，FBD 被广泛认为是大脑-肠道轴的双向疾病，在整个生命过程中对不同个体产生影响。研究必须整合大脑-肠道轴的各个组成部分，以及生物性别、生命早期压力源、遗传和表观遗传因素对个体患者的影响。第四，改善诊断和管理范式的研究重点包括增强医患关系、进行识别 FBD 风险和保护因素的纵向研究、确定症状严重程度和治疗反应的生物标志物和表型、以及纳入新兴的“组学”发现。这些范式可以由熟悉多模态治疗的训练有素的临床医生应用。第五，成功计划的基本组成部分包括生成一个经过严格表型分析的大型、验证、广泛可获得的数据库；一个平行、可链接的生物样本库；支持经过同行评审、基于假设的研究的专用资源；获得专用生物信息学专业知识的机会；以及由资助机构监督审查优先事项、进展情况以及与相关利益攸关方的潜在协同作用。
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