Article

The Brain-Gut Axis in Abdominal Pain Syndromes

Center for Neurobiology of Stress, Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Annual review of medicine (Impact Factor: 12.93). 02/2011; 62(1):381-96. DOI: 10.1146/annurev-med-012309-103958
Source: PubMed

ABSTRACT

The importance of bidirectional brain-gut interactions in gastrointestinal (GI) illness is increasingly recognized, most prominently in the area of functional GI syndromes such as irritable bowel syndrome (IBS), functional dyspepsia, and functional chest pain. The brain receives a constant stream of interoceptive input from the GI tract, integrates this information with other interoceptive information from the body and with contextual information from the environment, and sends an integrated response back to various target cells within the GI tract. This system is optimized to assure homeostasis of the GI tract during physiological perturbations and to adapt GI function to the overall state of the organism. In health, the great majority of interoceptive information reaching the brain is not consciously perceived but serves primarily as input to autonomic reflex pathways. In patients with functional abdominal pain syndromes, conscious perception of interoceptive information from the GI tract, or recall of interoceptive memories of such input, can occur in the form of constant or recurrent discomfort or pain. This is often associated with alterations in autonomic nervous system output and with emotional changes. A model is proposed that incorporates reported peripheral and central abnormalities in patients with IBS, extrapolates similar alterations in brain-gut interactions to patients with other chronic abdominal pain syndromes, and provides novel treatment targets.

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    • "Alterations in the microbiota have been shown in a variety of disorders ranging from obesity, diabetes to inflammatory bowel disorder and irritable bowel syndrome (IBS) (Kostic et al., 2014;Mayer et al., 2014;Moreno-Indias et al., 2014;Walsh et al., 2014). IBS is now recognized as a disorder of the brain–gut microbiome axis, characterized by visceral hypersensitivity, enhanced stress and anxiety (Mayer et al., 2001Mayer et al., , 2014Longstreth et al., 2006;Mayer and Tillisch, 2011;Fashner and Gitu, 2013). The early postnatal period is the most dynamic stage of intestinal microbiota development. "
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    ABSTRACT: Disruption of bacterial colonization during the early postnatal period is increasingly being linked to adverse health outcomes. Indeed, there is a growing appreciation that the gut microbiota plays a role in neurodevelopment. However, there is a paucity of information on the consequences of early-life manipulations of the gut microbiota on behavior. To this end we administered an antibiotic (vancomycin) from postnatal days 4-13 to male rat pups and assessed behavioral and physiological measures across all aspects of the brain-gut axis. In addition, we sought to confirm and expand the effects of early-life antibiotic treatment using a different antibiotic strategy (a cocktail of primaricin, bacitracin, neomycin; orally) during the same time period in both female and males rat pups. Vancomycin significantly altered the microbiota, which was restored to control levels by eight weeks of age. Notably, vancomycin treated animals displayed visceral hypersensitivity in adulthood without any significant effect on anxiety responses as assessed in the elevated plus maze or open field tests. Moreover, cognitive performance in the Morris water maze was not affected by early-life dysbiosis. Immune and stress-related physiological responses were equally unaffected. The early-life antibiotic-induced visceral hypersensitivity was also observed in male rats given the antibiotic cocktail. Both treatments did not alter visceral pain perception in female rats. Changes in visceral pain perception in males were paralleled by distinct decreases in the transient receptor potential cation channel subfamily V member 1, the α-2A adrenergic receptor and cholecystokinin B receptor. In conclusion, a temporary disruption of the gut microbiota in early-life results in very specific and long-lasting changes in visceral sensitivity in male rats, a hallmark of stress-related functional disorders of the brain-gut axis such as irritable bowel disorder.
    No preview · Article · Jul 2014 · Neuroscience
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    • "Known mechanisms of visceral pain pathogenesis include the following: (1) peripheral sensitization: inflammation, injury, or noxious stimuli in peripheral tissues cause sensitization of afferent nerve fibers; (2) central sensitization: sustained, amplified incoming noxious signals from the peripheral are transmitted through the visceral afferent fibers to activate neurons in the spinal dorsal horn; (3) noxious stimulation is transmitted to the spinal cord, leading to activation of endogenous descending facilitation, enhancing transmission of nociceptive information in the spinal dorsal horn. Signals arising from the gastrointestinal tract are transmitted into the brain through the visceral afferent pathways, which can be divided into the parasympathetic and sympathetic afferent pathways [7] [9]. The parasympathetic afferent pathways transmit incoming signals along the vagus nerve to the solitary nucleus, which then transmits the signals to various cortical limbic structures [8]. "
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    ABSTRACT: Irritable bowel syndrome (IBS) is a functional bowel disorder that causes recurrent abdominal (visceral) pain. Epidemiological data show that the incidence rate of IBS is as high as 25%. Most of the medications may lead to tolerance, addiction and toxic side effects. Moxibustion is an important component of traditional Chinese medicine and has been used to treat IBS-like abdominal pain for several thousand years in China. As a mild treatment, moxibustion has been widely applied in clinical treatment of visceral pain in IBS. In recent years, it has played an irreplaceable role in alternative medicine. Extensive clinical studies have demonstrated that moxibustion for treatment of visceral pain is simple, convenient, and inexpensive, and it is being accepted by an increasing number of patients. There have not been many studies investigating the analgesic mechanisms of moxibustion. Studies exploring the analgesic mechanisms have mainly focused on visceral hypersensitivity, brain-gut axis neuroendocrine system, and immune system. This paper reviews the latest developments in moxibustion use for treatment of visceral pain in IBS from these perspectives. It also evaluates potential problems in relevant studies on the mechanisms of moxibustion therapy to promote the application of moxibustion in the treatment of IBS.
    Full-text · Article · Jul 2014 · Evidence-based Complementary and Alternative Medicine
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    • "Known mechanisms of visceral pain pathogenesis include the following: (1) peripheral sensitization: inflammation, injury, or noxious stimuli in peripheral tissues cause sensitization of afferent nerve fibers; (2) central sensitization: sustained, amplified incoming noxious signals from the peripheral are transmitted through the visceral afferent fibers to activate neurons in the spinal dorsal horn; (3) noxious stimulation is transmitted to the spinal cord, leading to activation of endogenous descending facilitation, enhancing transmission of nociceptive information in the spinal dorsal horn. Signals arising from the gastrointestinal tract are transmitted into the brain through the visceral afferent pathways, which can be divided into the parasympathetic and sympathetic afferent pathways [7] [9]. The parasympathetic afferent pathways transmit incoming signals along the vagus nerve to the solitary nucleus, which then transmits the signals to various cortical limbic structures [8]. "

    Full-text · Dataset · Jul 2014
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