The brain-gut axis in abdominal pain syndromes

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...

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Bibliographic Details
Published in:Annual review of medicine 2011-01, Vol.62 (1), p.381-396
Main Authors: Mayer, Emeran A, Tillisch, Kirsten
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Pain - drug therapy
Abdominal Pain - physiopathology
Brain
Brain - drug effects
Brain - physiopathology
Chronic Disease
Female
Gastrointestinal diseases
Gastrointestinal Diseases - drug therapy
Gastrointestinal Diseases - microbiology
Gastrointestinal Diseases - physiopathology
Gastrointestinal Motility - drug effects
Homeostasis - drug effects
Humans
Male
Mast Cells - drug effects
Medical treatment
Neuroimmunomodulation - drug effects
Pain
Spinal Cord - drug effects
Spinal Cord - physiopathology
Syndrome
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Summary: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.
ISSN:0066-4219
1545-326X
DOI:10.1146/annurev-med-012309-103958