Ali M Khawar, Chen Jiande D Z
Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA.
Diagnostics (Basel). 2023 Jan 12;13(2):293. doi: 10.3390/diagnostics13020293.
Functional gastrointestinal disorders (FGID) and gastroesophageal reflux (GERD) disease affect a large global population and incur substantial health care costs. Impairment in gut-brain communication is one of the main causes of these disorders. The central nervous system (CNS) provides its inputs to the enteric nervous system (ENS) by modulating the autonomic nervous system (ANS) to control the gastrointestinal functions. Therefore, GERD and FGID's might be associated with autonomic dysfunction, which can be identified via heart rate variability (HRV). FGIDs may be treated by restoring the autonomic dysfunction via neuromodulation. This article reviews the roles of HRV in the assessment of autonomic function and dysfunction in (i) gastroesophageal reflux (GERD), and the following FGIDs: (ii) functional dyspepsia (FD) and gastroparesis, (iii) irritable bowel syndrome (IBS) and (iv) constipation. The roles of HRV in the assessment of autonomic responses to various interventions were also reviewed. We used PUBMED, Web of Science, Elsevier/Science direct and Scopus to search the eligible studies for each disorder, which also included the keyword 'heart rate variability'. The retrieved studies were screened and filtered to identify the most suitable studies using HRV parameters to associate the autonomic function with any of the above disorders. Studies involving both human and animal models were included. Based on analyses of HRV, GERD as well as the FGIDs were found to be associated with decreased parasympathetic activity and increased sympathetic nervous system activity with the autonomic balance shifted towards the sympathetic nervous system. In addition, the HRV methods were also reported to be able to assess the autonomic responses to various interventions (mostly neuromodulation), typically the enhancement of parasympathetic activity. In summary, GERD and FGIDs are associated with impaired autonomic dysfunction, mainly due to suppressed vagal and overactive sympathetic tone, which can be assessed noninvasively using HRV.
功能性胃肠疾病（FGID）和胃食管反流（GERD）疾病影响着全球大量人口，并产生了高昂的医疗费用。肠脑通讯受损是这些疾病的主要原因之一。中枢神经系统（CNS）通过调节自主神经系统（ANS）向肠神经系统（ENS）提供输入，以控制胃肠功能。因此，GERD和FGID可能与自主神经功能障碍有关，这可以通过心率变异性（HRV）来识别。FGID可以通过神经调节恢复自主神经功能障碍来进行治疗。本文综述了HRV在评估以下方面自主神经功能和功能障碍中的作用：（i）胃食管反流（GERD），以及以下FGID：（ii）功能性消化不良（FD）和胃轻瘫，（iii）肠易激综合征（IBS）和（iv）便秘。还综述了HRV在评估对各种干预措施的自主神经反应中的作用。我们使用PUBMED、科学网、爱思唯尔/科学Direct和Scopus搜索每种疾病的符合条件的研究，这些研究还包括关键词“心率变异性”。对检索到的研究进行筛选和过滤，以确定使用HRV参数将自主神经功能与上述任何一种疾病相关联的最合适研究。纳入了涉及人类和动物模型的研究。基于HRV分析，发现GERD以及FGID与副交感神经活动降低和交感神经系统活动增加有关，自主神经平衡向交感神经系统偏移。此外，据报道，HRV方法还能够评估对各种干预措施（主要是神经调节）的自主神经反应，通常是副交感神经活动的增强。总之，GERD和FGID与自主神经功能障碍受损有关，主要是由于迷走神经抑制和交感神经张力亢进，这可以使用HRV进行无创评估。
