Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura 285-8741, Japan.
Auton Neurosci. 2021 May;232:102795. doi: 10.1016/j.autneu.2021.102795. Epub 2021 Mar 13.
Disorders of the nervous system can produce a variety of gastrointestinal (GI) dysfunctions. Among these, lesions in various brain structures can cause appetite loss (hypothalamus), decreased peristalsis (presumably the basal ganglia, pontine defecation center/Barrington's nucleus), decreased abdominal strain (presumably parabrachial nucleus/Kolliker-Fuse nucleus) and hiccupping and vomiting (area postrema/dorsal vagal complex). In addition, decreased peristalsis with/without loss of bowel sensation can be caused by lesions of the spinal long tracts and the intermediolateral nucleus or of the peripheral nerves and myenteric plexus. Recently, neural diseases of inflammatory etiology, particularly those affecting the PNS, are being recognized to contribute to GI dysfunction. Here, we review neuroinflammatory diseases that potentially cause GI dysfunction. Among such CNS diseases are multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein associated disorder, and autoimmune encephalitis. Peripheral nervous system diseases impacting the gut include Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, acute sensory-autonomic neuropathy/acute motor-sensory-autonomic neuropathy, acute autonomic ganglionopathy, myasthenia gravis and acute autonomic neuropathy with paraneoplastic syndrome. Finally, collagen diseases, such as Sjogren syndrome and systemic sclerosis, and celiac disease affect both CNS and PNS. These neuro-associated GI dysfunctions may predate or present concurrently with brain, spinal cord or peripheral nerve dysfunction. Such patients may visit gastroenterologists or physicians first, before the neurological diagnosis is made. Therefore, awareness of these phenomena among general practitioners and collaboration between gastroenterologists and neurologists are highly recommended in order for their early diagnosis and optimal management, as well as for systematic documentation of their presentations and treatment.
神经系统疾病可导致多种胃肠道（GI）功能障碍。其中，各种脑结构的病变可引起食欲减退（下丘脑）、蠕动减少（推测为基底节、脑桥排便中枢/Barrington 核）、腹部张力降低（推测为臂旁核/楔束核）以及呃逆和呕吐（终板/背侧迷走复合核）。此外，脊髓长束和中间外侧核或周围神经和肌间神经丛的病变可引起蠕动减少伴/不伴肠感觉丧失。最近，炎症病因的神经疾病，特别是影响周围神经系统的疾病，被认为与 GI 功能障碍有关。在这里，我们回顾了可能导致 GI 功能障碍的神经炎症性疾病。这些中枢神经系统疾病包括多发性硬化症、视神经脊髓炎谱系疾病、髓鞘少突胶质细胞糖蛋白相关疾病和自身免疫性脑炎。影响肠道的周围神经系统疾病包括格林-巴利综合征、慢性炎症性脱髓鞘性多发性神经病、急性感觉-自主神经病/急性运动-感觉-自主神经病、急性自主神经节病变、重症肌无力和副肿瘤综合征伴急性自主神经病变。最后，胶原疾病，如干燥综合征和系统性硬化症以及乳糜泻，同时影响中枢神经系统和周围神经系统。这些与神经相关的 GI 功能障碍可能先于或与脑、脊髓或周围神经功能障碍同时发生。这些患者可能会先去看胃肠病医生或内科医生，然后才做出神经诊断。因此，强烈建议普通医生和胃肠病医生与神经科医生之间建立意识，并进行合作，以便早期诊断和最佳管理，以及系统地记录其表现和治疗。
