Di Nardo Giovanni, Cremon Cesare, Staiano Annamaria, Stanghellini Vincenzo, Borrelli Osvaldo, Strisciuglio Caterina, Romano Claudio, Mallardo Saverio, Scarpato Elena, Marasco Giovanni, Salvatore Silvia, Zenzeri Letizia, Felici Enrico, Pensabene Licia, Sestito Simona, Francavilla Ruggiero, Quitadamo Paolo, Baldassarre Mariella, Giorgio Valentina, Tambucci Renato, Ziparo Chiara, Parisi Pasquale, Barbaro Maria Raffaella, Barbara Giovanni
NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Neurogastroenterol Motil. 2023 Mar;35(3):e14365. doi: 10.1111/nmo.14365. Epub 2022 Mar 27.
IBS affects a large number of children throughout the world and is thought to be the result of disturbed neuroimmune function along with the brain-gut axis. Although the underlying pathophysiologic mechanisms are not clear, the role of low-grade inflammation and mucosal immune activation in IBS symptom generation has become evident also in subsets of pediatric patients. Animal models provided meaningful insight in the causal relationship between abnormal mucosal immune activation and changes in gastrointestinal (GI) sensory-motor function. Likewise, the development of long-standing GI symptoms fulfilling the current criteria for functional GI disorders after infection gastroenteritis and in patients with IBD or celiac disease in remission further supports this hypothesis. Immune activation, its impact on gut sensory-motor function, and potential implications for symptom generation emerged in both children and adults with IBS.
The aim of this review is to summarize the main evidence on the presence of low-grade inflammation and immune activation in children with IBS, its possible role in symptom generation, and its potential implication for new therapeutic strategies.
肠易激综合征影响着全球大量儿童，被认为是神经免疫功能紊乱以及脑-肠轴异常的结果。尽管潜在的病理生理机制尚不清楚，但低度炎症和黏膜免疫激活在肠易激综合征症状产生中的作用在部分儿科患者中也已显现。动物模型为异常黏膜免疫激活与胃肠（GI）感觉运动功能变化之间的因果关系提供了有意义的见解。同样，感染性肠胃炎后出现符合当前功能性胃肠疾病标准的长期胃肠症状，以及炎症性肠病或乳糜泻缓解期患者出现此类症状，进一步支持了这一假说。免疫激活、其对肠道感觉运动功能的影响以及对症状产生的潜在影响在儿童和成人肠易激综合征患者中均有体现。
本综述的目的是总结关于肠易激综合征患儿存在低度炎症和免疫激活的主要证据、其在症状产生中的可能作用以及对新治疗策略的潜在影响。
