Highlights
- •The brain-gut-microbiotal axis is a complex network with influences on gut physiology.
- •Includes interconnections between the central and enteric nervous systems with inputs from hormones, immune cells, and gut microbiota
- •Perturbances play a critical role in the development of functional gastrointestinal disorders
- •Provides a rational basis for behavioral, pharmacologic, and microbiotal treatments
- •Therapies include medications, dietary modifications, and psychotherapy
Abstract
Functional gastrointestinal disorders (FGIDs), characterized by chronic abdominal
complaints without a structural or biochemical cause, are common diseases that are
frequently encountered by specialists in internal medicine. Collectively, irritable
bowel syndrome (IBS) and functional dyspepsia are estimated to affect up to 22% of
the population, and are often associated with additional somatic and pain complaints,
all without an obvious structural source [
[1]
,
- Ford AC
- Marwaha A
- Sood R
- Moayyedi P.
Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis.
Gut. 2015; 64 (Epub 2014/08/26PubMed PMID: 25147201): 1049-1057https://doi.org/10.1136/gutjnl-2014-307843
[2]
. An appreciation of the current understanding of the mechanistic basis for these
disorders is key to developing treatment goals and optimization of patient management
strategies. In recent years, the brain-gut axis increasingly has been recognized as
a central factor in the experience of functional abdominal pain disorders, including
the most recent Rome IV guidelines which identify FGIDs as disorders of gut-brain
interaction [
[3]
]. The brain-gut axis (BGA), simply defined, is a complex network of bidirectional
communication between the central and enteric nervous systems. This axis broadly includes
all the systems involved with communication between the GI tract and central nervous
system (CNS), with principle inputs into this network occurring between the CNS, enteric
nervous system (ENS), and autonomic nervous systems (ANS), but also includes interfaces
with numerous other factors, including endocrine hormones and immune effector cells
as well as interactions with the gut microbiota. Perturbances to this system have
been found to play a critical role in the development of visceral hypersensitivity,
bowel dysregulation, and mood. This review will summarize the principle processes
involved in the neurologic and biologic function of the brain-gut axis, our current
understanding of its role in functional GI disorders, and potential targets for therapeutic
intervention.- Drossman DA
- Hasler WL.
Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction.
Gastroenterology. 2016; 150 (Epub 2016/05/06PubMed PMID: 27147121): 1257-1261https://doi.org/10.1053/j.gastro.2016.03.035
Keywords
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Article info
Publication history
Published online: January 07, 2021
Accepted:
December 9,
2020
Received in revised form:
December 5,
2020
Received:
January 11,
2020
Identification
Copyright
Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
