G. Oppenheimer Center for Neurobiology of Stress and Resilience, Departments of Medicine, Psychiatry and Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
A.T. Still University School of Osteopathic Medicine in Arizona, Meza, AZ, USA.
Mol Psychiatry. 2023 Apr;28(4):1451-1465. doi: 10.1038/s41380-023-01972-w. Epub 2023 Feb 2.
Irritable bowel syndrome (IBS) is the most prevalent disorder of brain-gut interactions that affects between 5 and 10% of the general population worldwide. The current symptom criteria restrict the diagnosis to recurrent abdominal pain associated with altered bowel habits, but the majority of patients also report non-painful abdominal discomfort, associated psychiatric conditions (anxiety and depression), as well as other visceral and somatic pain-related symptoms. For decades, IBS was considered an intestinal motility disorder, and more recently a gut disorder. However, based on an extensive body of reported information about central, peripheral mechanisms and genetic factors involved in the pathophysiology of IBS symptoms, a comprehensive disease model of brain-gut-microbiome interactions has emerged, which can explain altered bowel habits, chronic abdominal pain, and psychiatric comorbidities. In this review, we will first describe novel insights into several key components of brain-gut microbiome interactions, starting with reported alterations in the gut connectome and enteric nervous system, and a list of distinct functional and structural brain signatures, and comparing them to the proposed brain alterations in anxiety disorders. We will then point out the emerging correlations between the brain networks with the genomic, gastrointestinal, immune, and gut microbiome-related parameters. We will incorporate this new information into a systems-based disease model of IBS. Finally, we will discuss the implications of such a model for the improved understanding of the disorder and the development of more effective treatment approaches in the future.
肠易激综合征(IBS)是最常见的脑-肠相互作用紊乱,影响全球 5%至 10%的普通人群。目前的症状标准将诊断限制为与改变的肠道习惯相关的反复发作的腹痛,但大多数患者还报告非疼痛性腹部不适、相关精神疾病(焦虑和抑郁)以及其他内脏和躯体疼痛相关症状。几十年来,IBS 被认为是一种肠道动力障碍,最近又被认为是一种肠道疾病。然而,基于大量关于涉及 IBS 症状病理生理学的中枢、外周机制和遗传因素的报告信息,出现了一种全面的脑-肠-微生物组相互作用疾病模型,可以解释改变的肠道习惯、慢性腹痛和精神共病。在这篇综述中,我们将首先描述脑-肠微生物组相互作用的几个关键组成部分的新见解,从报告的肠道连接组和肠神经系统的改变开始,以及一系列独特的功能和结构的大脑特征,并将其与焦虑障碍中提出的大脑改变进行比较。然后,我们将指出大脑网络与基因组、胃肠道、免疫和肠道微生物组相关参数之间新兴的相关性。我们将把这些新信息纳入 IBS 的基于系统的疾病模型中。最后,我们将讨论这样一个模型对更好地理解这种疾病以及未来开发更有效的治疗方法的意义。
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