Department of Molecular Neurology and Therapeutics, Kumamoto University Hospital, Kumamoto, Japan.
Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Immunol Med. 2021 Jun;44(2):74-85. doi: 10.1080/25785826.2020.1797319. Epub 2020 Jul 27.
Autoimmune gastrointestinal dysmotility (AGID), an idiopathic or paraneoplastic phenomenon, is a clinical form of limited autoimmune dysautonomia. The symptoms of AGID and gastrointestinal manifestations in patients with autoimmune rheumatic diseases are overlapping. Antineuronal autoantibodies are often detected in patients with AGID. Autoantibodies play a key role in GI dysmotility; however, whether they cause neuronal destruction is unknown. Hence, the connection between the presence of these autoantibodies and the specific interference in synaptic transmission in the plexus ganglia of the enteric nervous system has to be determined. The treatment options for AGID are not well-defined. However, theoretically, immunomodulatory therapies have been shown to be effective and are therefore used as the first line of treatment. Nonetheless, diverse combined immunomodulatory therapies should be considered for intractable cases of AGID. We recommend comprehensive autoimmune evaluation and cancer screening for clinical diagnosis of AGID. Univocal diagnostic criteria, treatment protocols, and outcome definitions for AGID are required for prompt diagnosis and treatment and appropriate management of immunotherapy, which will circumvent the need for surgeries and improve patient outcome. In conclusion, AGID, a disease at the interface of clinical immunology and neurogastroenterology, requires further investigations and warrants cooperation among specialists, especially clinical immunologists, gastroenterologists, and neurologists.
自身免疫性胃肠动力障碍(AGID)是一种特发性或副肿瘤现象,是有限自身免疫性自主神经障碍的一种临床形式。AGID 的症状和自身免疫性风湿病患者的胃肠道表现存在重叠。AGID 患者常检测到神经元自身抗体。自身抗体在胃肠动力障碍中起关键作用;然而,它们是否导致神经元破坏尚不清楚。因此,必须确定这些自身抗体的存在与肠神经系统神经丛中突触传递的特定干扰之间的联系。AGID 的治疗选择尚未明确。然而,从理论上讲,免疫调节疗法已被证明有效,因此被用作一线治疗。尽管如此,对于难治性 AGID 病例,应考虑多种联合免疫调节疗法。我们建议进行全面的自身免疫评估和癌症筛查,以进行 AGID 的临床诊断。需要明确的诊断标准、治疗方案和 AGID 的结果定义,以便及时诊断和治疗,并适当管理免疫治疗,这将避免手术的需要,并改善患者的预后。总之,AGID 是临床免疫学和神经胃肠病学之间的交叉疾病,需要进一步研究,并需要专家之间的合作,特别是临床免疫学家、胃肠病学家和神经学家之间的合作。
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