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The Brain-Gut-Microbiotal Axis: A framework for understanding functional GI illness and their therapeutic interventions

  • Christopher Tait
    Affiliations
    Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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  • Gregory S. Sayuk
    Correspondence
    Address all correspondence to: Gregory S. Sayuk, MD, MPH, Washington University School of Medicine, Division of Gastroenterology, 660 S. Euclid Ave, Box 8124, St Louis, Missouri USA 63110. 314.454.8201.
    Affiliations
    Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri

    Department of Psychiatry at Washington University in St. Louis School of Medicine, St. Louis, Missouri

    Gastroenterology Section, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
    Search for articles by this author
Published:January 07, 2021DOI:https://doi.org/10.1016/j.ejim.2020.12.023

      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 [
      • Ford AC
      • Marwaha A
      • Sood R
      • Moayyedi P.
      Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis.
      ,
      • Hungin AP
      • Whorwell PJ
      • Tack J
      • Mearin F.
      The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects.
      . 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 [
      • Drossman DA
      • Hasler WL.
      Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction.
      ]. 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.

      Keywords

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