Brain-Gut Axis: From Basic Understanding to Treatment of IBS and Related Disorders

Clinical Enteric Neuroscience Translational and Epidemiological Research, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Journal of pediatric gastroenterology and nutrition (Impact Factor: 2.63). 10/2011; 54(4):446-53. DOI: 10.1097/MPG.0b013e31823d34c3
Source: PubMed


The present review describes advances in understanding the mechanisms and provide an update of present and promising therapy directed at the gut or the brain in the treatment of irritable bowel syndrome (IBS). The diagnosis of IBS typically is based on identification of symptoms, such as the Rome III criteria for IBS in adults and children. The criteria are similar in children and adults. The focus of the present review is the bowel dysfunction associated with IBS.

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Available from: Michael Camilleri, Jul 14, 2015
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    • "As the importance of the human brain in FD becomes more widely recognized, the evolving treatments of FD began to include drugs targeting at the human brain in addition to typical drugs directly modulating gastrointestinal function [3]. Despite the availability of pharmaceutical interventions, treatments of FD remain unsatisfactory [3]. During the past decades, acupuncture has gained popularity in the management of FD in both China and other Eastern Asian countries. "
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    ABSTRACT: Objective. To explore acupuncture effects on brain functional connectivity in patients with functional dyspepsia (FD). Methods. Eight patients in an acupuncture treatment group and ten healthy adults in the control group participated in the study. Acupuncture effectiveness was evaluated based on changes of the gastrointestinal symptoms, gastric motility measurements, and gastrin levels and comparisons with the control group when appropriate. To investigate functional connectivity changes related to FD and potential modulation after acupuncture, a set of regions of interest (ROIs) were selected according to previous fMRI reports of acupuncture. Results. Patients showed significant improvements of FD signs and symptoms after acupuncture treatments. For all of the ROIs, we identified subportions of the networks showing reduced connectivity in patients with FD. Connectivity between the ROIs and corresponding disease targets showed significant improvement after acupuncture treatment () in all ROIs except for right medial temporal lobe-hippocampus and right inferior parietal lobule. Conclusion. Functional connectivity of the brain is changed in patients with FD but approximates that in healthy control after acupuncture treatment. The relief of gastrointestinal signs and symptoms by acupuncture is likely due to the normalization of brain-gut axis associated with FD.
    Full-text · Article · Nov 2015 · Evidence-based Complementary and Alternative Medicine
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    • "the advent of a number of neurophysiological techniques, that these interactions have been studied non-invasively in vivo. This increased understanding has led to the development of the concept of the brain–gut axis, a bidirectional intercommunication between the gut and the brain, providing an explanation of both normal activity and acute and chronic perturbations of GI function (Camilleri & Di Lorenzo, 2012). Moreover, this model of circuitous communication underpins the biopsychosocial concept, first explicitly formulated by George Engel in the late 1970s, postulates that all illnesses, but especially in GI disorders, result from a complex reciprocal interaction between biological/genetic, psychological and social factors (Engel, 1977). "
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    ABSTRACT: Common human experience shows that stress and anxiety may modulate gut function. Such observations have been combined with an increasing experimental evidence base have culminated in the concept of the brain-gut axis. Nevertheless, it has not been until recently that the gut and its attendant components, have been considered to influence higher cerebral function and behaviour per se. Moreover, the proposal that the gut and the bacteria contained therein (collectively referred to as the microbiota) can modulate mood and behaviours, has an increasing body of supporting evidence, albeit largely derived from animal studies. The gut microbiota is a dynamic and diverse ecosystem and forms a symbiotic relationship with the host. Herein we describe the components of the gut microbiota and mechanisms by which it can influence neural development, complex behaviours and nociception. Furthermore, we propose the novel concept of a ‘state of gut’ rather than a state of mind, particularly in relation to functional bowel disorders. Finally, we address the exciting possibility that the gut microbiota may offer a novel area of therapeutic intervention across a diverse array of both affective and GI disorders.This article is protected by copyright. All rights reserved
    Full-text · Article · Mar 2014 · The Journal of Physiology
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    • "Briefly, prefrontal lobe may modulate the neural activities coming from limbic and paralimbic regions, anterior cingulate cortex and hypothalamus, which in turn down modifies the activities of descending inhibitory and facilitatory pathways through the periaqueductal gray and pontomedullary nuclei. The neuronal activities among these corticolimbic pontine networks can coordinate the final perception of cognitional and emotional impacts on the visceral pain and discomfort.87 The putative neurolimbic pain network of migraine maybe adoptable to the IBS although the neuro-pathways or networks of both disorders may not be exactly the same. "
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    ABSTRACT: Irritable bowel syndrome (IBS) and migraine are distinct clinical disorders. Apart from the characteristics of chronic and recurrent pain in nature, these pain-related disorders apparently share many similarities. For example, IBS is female predominant with community prevalence about 5-10%, whereas that of migraine is 1-3% also showing female predominance. They are often associated with many somatic and psychiatric comorbidities in terms of fibromyaglia, chronic fatigue syndrome, interstitial cystitis, insomnia and depression etc., even the IBS subjects may have coexisted migraine with an estimated odds ratio of 2.66. They similarly reduce the quality of life of victims leading to the social, medical and economic burdens. Their pathogeneses have been somewhat addressed in relation to biopsychosocial dysfunction, heredity, genetic polymorphism, central/visceral hypersensitivity, somatic/cutaneous allodynia, neurolimbic pain network, gonadal hormones and abuses etc. Both disorders are diagnosed according to the symptomatically based criteria. Multidisciplinary managements such as receptor target new drugs, melantonin, antispasmodics, and psychological drugs and measures, complementary and alternatives etc. are recommended to treat them although the used agents may not be necessarily the same. Finally, the prognosis of IBS is pretty good, whereas that of migraine is less fair since suicide attempt and stroke are at risk. In conclusion, both distinct chronic pain disorders to share many similarities among various aspects probably suggest that they may locate within the same spectrum of a pain-centered disorder such as central sensitization syndromes. The true pathogenesis to involve these disorders remains to be clarified in the future.
    Full-text · Article · Jul 2013 · Journal of neurogastroenterology and motility
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