Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pansini, 5, I-80131, Naples, Italy.
Hormones (Athens). 2019 Dec;18(4):395-399. doi: 10.1007/s42000-019-00113-9. Epub 2019 Jun 21.
There is accumulating evidence showing that obesity is due not merely to increased food intake, but could have a more complex pathophysiology possibly originating from the gut. Due to its microbiological, hormonal, and nutritional aspects, the gut could represent a starting point for the treatment of weight excess. Obesity is associated with a change of microbiota composition that not only could increase the calorie extraction from food but also could create a functional derangement resulting in irritable bowel syndrome (IBS). Several mechanisms have been postulated to explain this association, such as specific foods that are poorly absorbed, i.e., carbohydrates and lipids, as well as conditions of psychological stress which could stimulate colonic hypersensitivity giving rise to IBS symptoms. Another factor involved in this link could be the subclinical inflammation typical of obesity, characterized by the release of inflammatory mediators that can irritate intestinal nerve endings. The change of levels of some anorexigenic hormones, as well as the alterations of the gut microbiota with the reduction of the bacteroides/Firmicutes ratio, could also contribute to the pathogenesis of IBS related to obesity. Thus, the aim of this manuscript is to review the current evidence on the association between obesity and IBS while providing physiopathological hypotheses that may explain this link. Further, we will report the effect of weight loss on IBS symptoms, highlighting the importance of an accurate assessment of gut function in obese patients.
越来越多的证据表明，肥胖不仅是由于食物摄入增加引起的，其可能具有更复杂的病理生理学机制，其根源可能来自于肠道。由于肠道具有微生物学、激素和营养方面的特点，它可能成为治疗体重超标的起点。肥胖与微生物群落组成的变化有关，这种变化不仅会增加食物的热量提取，还会导致功能性紊乱，从而引发肠易激综合征（IBS）。已经提出了几种机制来解释这种关联，例如某些不易被吸收的食物，如碳水化合物和脂肪，以及可能刺激结肠高敏感性从而导致 IBS 症状的心理压力等条件。与肥胖相关的 IBS 中还涉及到另一个因素，即肥胖的亚临床炎症，其特征是释放的炎症介质会刺激肠神经末梢。一些厌食激素水平的变化，以及肠道微生物群落的改变，导致拟杆菌/厚壁菌比值降低，也可能导致与肥胖相关的 IBS 的发病机制。因此，本文的目的是综述肥胖与 IBS 之间关联的现有证据，并提供可能解释这种关联的病理生理学假设。此外，我们还将报告体重减轻对 IBS 症状的影响，强调对肥胖患者肠道功能进行准确评估的重要性。
