内脏高敏感与功能性胃肠病

功能性胃肠病（functional gastrointestinal disorders，FGIDs）是指一组以慢性或反复发作的消化道症状就诊，但无明确胃肠黏膜结构改变或生化异常可查的症候群。心理、社会因素可加重FGIDs患者症状，患者可同时伴有躯体症状。其发病机制目前尚不明确，最初该类疾病被认为是胃肠神经官能症，大量的流行病学资料表明，尽管精神压力与患者症状发作有关，但主要还是决定于患者的就医行为。此后，FGIDs发病机制的研究又集中在胃肠动力改变方面，肠易激综合征患者（IBS）、功能性消化不良患者（FD）、非心源性胸痛患者（NCCP）均发现了各种胃肠动力异常，但它与患者症状相关性较差，无法解释FGIDs患者多种多样的症状。近年研究发现，FGIDs患者胃肠道存在一个或多个部位对机械或化学刺激的敏感性增高。目前认为，内脏高敏感是功能性胃肠病症状产生的主要原因之一。因此，近年来其产生的部位、发病机制及其调节已成为功能性胃肠病研究的热点。     

肠道菌群：功能性胃肠病的防治新靶点

功能性胃肠病（FGIDs）是一组无器质性改变但存在消化功能异常的疾病,是消化科门诊中常见疾病之一。在 最新的罗马Ⅳ标准中将功能性肠胃病定义为脑-肠互动异常疾病。肠道菌群在脑-肠互动中发挥重要作用,参与功 能性胃肠病发生的多种病理生理机制。肠道菌群失调主要通过增加肠道渗透及内脏高敏感性、改变肠道动力和激活 免疫反应参与FGIDs症状产生。因此,重塑肠道菌群稳态的策略在治疗FGIDs中显示出一定的前景。     

影像学检查在胃肠功能性疾病中的应用价值

功能性胃肠病(FGIDs)是消化系统较常见的疾病。主要为胃肠道的运动与分泌功能失调及感觉异常,而无器质性病理改变。临床常主要表现为腹痛、腹胀、恶心、早饱、呕吐、腹泻及排便困难等症状,也可伴有其它功能性症状。长期以来,由于无法获得客观的FGIDs依据,临床医生对FGIDs的诊断     

功能性胃肠病内脏高敏感与Cajal间质细胞相关性研究进展

目的 功能性胃肠病(FGIDs)是一组常见的消化科疾病,发病机制包括胃肠运动异常、内脏敏感性增高、炎症、脑-肠互动、心理社会因素5个方面.近年研究发现,内脏高敏感性可以被认为是FGIDs的一个生物学指标.胃肠道ICC的数目、分布及超微结构的改变,在功能性胃肠病的发生、发展过程中起重要作用.但要明确诊断ICC异常与功能性胃肠病相关性,并为功能性胃肠病的药物治疗提供新的靶点,仍需做大量相关研究.     

重视炎症在功能性胃肠疾病中的作用

功能性胃肠病指临床上无法找到病理解剖学或生物化学异常的慢性或复发性胃肠道症候群。这些症候群因发生部位和症状特征而有不同命名，主要包括功能性消化不良（FD）和肠易激综合征（IBS）等。胃肠道急性炎症产生的症状已得到充分认识，但炎症消退或“治愈”后部分患者出现慢性或复发性胃肠道症候群的机制尚不完全清楚。阐明感染后功能性胃肠病的易感因素和机制对功能性胃肠病的预防和治疗有重要意义。     

肠易激综合征药物治疗的循证医学评价

肠易激综合征是肠道动力和感觉异常的功能性肠病,人群患病率较高,但发病机制仍然不明,目前认为与胃肠动力异常、内脏感觉过敏、脑一肠轴改变、精神心理异常等多种因素有关。治疗IBS的药物种类较多,但主要是缓解症状,改善患者生活质量。目前评价治疗肠易激综合征药物疗效的临床试验越来越多,本文从循证医学的角度总结了近期有关6种主要药物（包括解痉剂、导泻药、止泻剂、肠道动力感觉调节剂、微生态制剂和抗抑郁药）的临床试验和综述,评价其疗效和安全性。     

肠神经系统在功能性胃肠病发病中的作用

肠神经系统对胃肠道运动、分泌和血液供应具有独立的调节作用,功能性胃肠病（FGIDs）的慢性症状如腹泻、便秘和疼痛与肠神经调控的胃肠道功能异常有关。某些FGIDs存在肠神经递质表达异常,甚至神经元退行性改变;肠神经系统与肠道Cajal间质细胞、胶质细胞和免疫细胞连接和功能的异常亦可能参与了FGIDs的发病;脑-肠轴功能紊乱是应激和感染后肠易激综合征的发病机制之一。肠神经系统在FGIDs的发病中具有重要作用,以肠神经为靶点为开发治疗FGIDs的有效药物开辟了广阔的前景。     

急性胃肠道感染后功能性胃肠病

功能性胃肠病（FGIDs）是一组胃肠道功能紊乱性疾病,目前研究最多的为肠易激综合征（IBS）和功能性消化不良（FD）。目前认为FGIDs主要是胃肠动力异常和内脏高敏感的结果,而在造成这些病理生理改变的原因中,胃肠道感染的作用日益受到重视。研究表明,急性胃肠道细菌感染可能是部分FGIDs的促发因素,通过持续胃肠道黏膜炎症和免疫反应引起一系列病理生理改变和相关症状,5-羟色胺和肥大细胞代谢系统异常可能是其重要的发生机制。     

生活质量评价与功能性胃肠病

功能性胃肠病作为一组无结构或生化异常可解释的胃肠道症状群 ,临床非常常见。这类疾病常常有慢性化的倾向 ,却无相关的生物学诊断和评价标志 ,也无特异性的功能障碍评价指标和这类疾病相关的死亡率[1] 。目前采用的以症状为基础的诊断标准与患者自己评价的健康状态的相关性差。尽管功能性胃肠病是非致命性的疾病 ,但对患者的日常活动、健康、社会行为和心理状态有明显的影响[2 ] 。因此 ,对功能性胃肠病的评价主要依赖患者的主观体验的表述 ,这种表述实质是健康相关生活质量所研究的内容[3 ] 。所以 ,重视功能性胃肠病相关的生活质量研究已…     

抗焦虑药物辅助治疗功能性胃肠病临床疗效分析

功能性胃肠病（FGIDS）主要包括功能性消化不良、肠易激综合征和功能性便秘,表现为慢性或者反复发作的胃肠道症状［1］。大部分 FGIDS 患者均有叠加症状,严重影响患者的生活质量。有研究显示,遗传背景、心理因素在该病的发生发展中起着重要作用［2］。因此,应在对症治疗的基础上,辅以抗焦虑药物治疗,心理因素和抗焦虑药物在 FGID 治疗中的作用广泛受到重视［3］。我们对抗焦虑药物在辅助治疗 FGIDS 患者中的疗效及重要性进行分析。     

大麻素系统与胃肠道内脏痛调控关系的研究进展

腹痛是功能性胃肠病（FGIDs）,特别是肠易激综合征（IBS）的主要症状之一,严重影响患者的生活质量。然而,其病理生理学机制复杂且仍未明确。大麻素已被应用于疼痛机制的研究和临床治疗,但成瘾性等中枢系统不良反应限制了其应用。因此,研究大麻素系统的外周作用途径,对提高大麻素治疗慢性疼痛（特别是内脏痛）的效果,具有重要意义。本文就大麻素系统与胃肠道内脏痛调控关系的研究进展作一综述。     

肠神经系统退行性变的研究进展

肠神经系统(enteric nervous system,ENS)可独立调节胃肠道感觉、分泌和运动功能,ENS退行性变可导致胃肠道功能的异常,引起一系列的临床症状,其与胃肠动力性疾病和功能性胃肠病的发病有关。本文就导致ENS退行性变的原因、肠神经元退行性变引起的功能异常及其与临床症状的关联性、可能的治疗靶点等方面的研究进展作一概述。     

Central nervous system involvement in functional gastrointestinal disorders

Although functional gastrointestinal disorders (FGID) are common, their pathophysiology remains incompletely understood. It is generally accepted that dysfunction of the bidirectional pathways between the gastrointestinal tract and the central nervous system (the 'brain-gut axis') at any level can cause FGID symptoms. In this review article, we focus on the role of the central nervous system in the brain-gut axis. First, we describe the functional anatomy of the brain-gut axis. Second, we focus on the results from brain-imaging studies both in healthy volunteers and in FGID patients. These new investigational techniques made identification of brain regions critically involved in processing of visceral afferent information possible. Differences in central nervous system response to visceral stimuli between controls and FGID patients will be highlighted. Third, we will address the issue of high comorbidity with psychiatric disorders. Some hypotheses about common pathophysiological substrates will be discussed.     

Gastrointestinal motility problems in the elderly patient

Statistics abound demonstrating the aging of the population, and this comes as no news to physicians caring for an increasing number of elderly patients. This group experiences the expected age-related physiologic declines, including systems critical to integrative functions such as immunologic, neurologic, and metabolic systems. Although an increased prevalence of several common gastrointestinal disorders occurs in the elderly person, aging per se appears to have less direct effect on most gastrointestinal functions, in large part because of the functional reserve of the gastrointestinal tract. Although irritable bowel symptoms decrease with aging, there seems to be an increase in many gastrointestinal disorders of function and motility. The gastroenterologist will frequently encounter elderly patients with complaints of dysphagia, anorexia, dyspepsia, and disorders of colonic function. Understanding age-related changes in gastrointestinal physiology and effects of common comorbid illnesses enhances the ability to evaluate and treat these common, troublesome symptoms.     

Opioid-induced bowel dysfunction

Opinion statement Opioid analgesics are commonly prescribed for moderate to severe pain. Opioids exert effects via receptors in the central and enteric nervous systems. Thus, central opioid analgesia can be limited by side effects involving the gastrointestinal tract, particularly by gastrointestinal motility delay. Opioid-induced bowel dysfunction is commonly treated with bulking agents, stimulant laxatives, lubiprostone, and tegaserod (removed from the market in March 2007). However, these treatments’ efficacy in opioid bowel dysfunction has not been proven. Recent research has focused on developing peripheral μ opioid antagonists such as methylnatrexone and alvimopan. These drugs selectively block μ opioid receptors in the enteric nervous system without penetrating the blood-brain barrier and can avert adverse gastrointestinal symptoms of opioids without reducing central analgesia. Methylnaltrexone and alvimopan also reduce hospitalization duration in surgical patients with postoperative ileus. A second line of research has focused on peripheral κ opioid agonists that modulate nociception in the enteric nervous system without producing central nervous system side effects. Asimadoline and fedotozine reduce nociceptive reflexes caused by gut distention and improve pain symptoms in patients with irritable bowel syndrome. ADL 10-0101 (Adolor Corp., Exton, PA) is another peripheral κ opioid agonist that lowers pain scores in patients with chronic pancreatitis. Although peripheral κ opioid agonists are promising, clinical studies are needed to assess their efficacy in treating opioid-induced bowel dysfunction.     

Funktionelle Dyspepsie und funktionelle Ösophaguserkrankungen

Functional disorders of the esophagus, stomach or bowel represent a large spectrum of digestive disorders characterized by defined symptoms specific to the gastrointestinal tract (GI). In patients with functional dyspepsia (FD) pain, early satiety or fullness are the key symptoms. Patients with functional disorders of the esophagus are typically affected by heartburn or dysphagia. A functional disorder is diagnosed if relevant chronic or relapsing symptoms exist and a diagnostic work-up utilising routine clinical tests does not reveal a cause for the symptoms. It is important to note that symptoms of FD and functional symptoms of the esophagus frequently coexist with symptoms of irritable bowel syndrome (IBS). This may suggest that there is a common pathophysiological basis. Overlap typically occurs in patients with more severe impairment from symptoms. It is remarkable that in these patients there are significant psychiatric comorbidities which may suggest that central nervous system (CNS) factors play a role for symptom manifestation. While the underlying pathophysiology is as yet not fully explained there is sufficient evidence to assume that alterations of sensory and motor function are critical for the manifestation of symptoms. More recently the role of minimal mucosal and systemic inflammation has been discovered. Alterations of the gastrointestinal microbiome are probably key for the inflammatory changes. While much attention is given to stool microbiome it is more likely than not that the mucosal microbiome is critical instead of the composition of stool. Technical developments such as the Brisbane biopsy device in combination with the refinement of extraction and sequencing methods might be critical for the future to gain insights into this new and emerging field.     

Altered neuro-endocrine–immune pathways in the irritable bowel syndrome: the top-down and the bottom-up model

The interaction between the brain and the gut as a pathological mechanism of functional gastrointestinal disorders has been recently recognized in the pathophysiology of the irritable bowel syndrome. Communication between central nervous system and enteric nervous system is two-directional: the brain can influence the function of the enteric nervous system and the gut can influence the brain via vagal and sympathetic afferents. In patients with irritable bowel syndrome, symptoms may be caused by alterations either primarily in the central nervous system (top-down model), or in the gut (bottom-up model), or in a combination of both. The brain–gut axis may be stimulated by various stressors either directed to the central nervous system (exteroreceptive stress) or to the gut (interoceptive stress). Particularly, clinical evidence suggest that in complex and multifactorial diseases such as irritable bowel syndrome, psychological disorders represent significant factors in the pathogenesis and course of the syndrome. Neuroimaging techniques have shown functional differences between central process in healthy subjects and patients with irritable bowel syndrome. Moreover, a high prevalence of psychological/psychiatric disorders have been reported in IBS patients compared to controls. Several data also suggest an alteration of neuro-endocrine and autonomic output to the periphery in these patients. This review will examine and discuss the complex interplay of neuro-endocrine–immune pathways, closely associated with neuropsychiatric disorders.     

Overview of functional gastrointestinal disorders: dysfunction of the brain-gut axis

Functional gastrointestinal disorders are common and incompletely understood. The gut is controlled by a complex interaction of sensory and motor neurons in the local enteric nervous system. Inputs from the central nervous system modify gut function, whereas inputs from the gut to the brain mediate symptoms. Dysfunction at one or more sites in the brain-gut axis is likely to produce the various functional gastrointestinal syndromes. Therapies likewise can be directed at one or more levels.     

脑肠互动与针刺治疗功能性胃肠病的相关性

功能性胃肠病是临床上常见的消化系统疾病,也是针刺治疗的优势病种.近年来的研究表明,脑肠轴功能失调是功能性胃肠病发病的重要原因,而针刺对脑肠轴的调节作用是其治疗功能性胃肠病的主要着眼点.随着脑功能成像技术的发展和脑肠肽研究的进展,功能性胃肠病与中枢神经系统及脑肠肽代谢相关性的研究日益增多.针灸作为传统中医疗法的一部分,治疗功能性胃肠病疗效显著,被广泛运用于临床.大量研究显示,针刺既能调节中枢神经系统,也能调控脑肠肽代谢.本文拟从中枢神经系统、脑肠肽代谢两方面,探讨脑肠互动与针刺治疗功能性胃肠病的相关性.