Review article: modulation of the brain–gut axis as a therapeutic approach in gastrointestinal disease

Abstract

SummaryBackgroundThe importance of bi‐directional brain‐gut interactions in gastrointestinal illness is increasingly being recognized, most prominently in the area of functional gastrointestinal disorders. Numerous current and emerging therapies aimed at normalizing brain–gut interactions are a focus of interest, particularly for irritable bowel syndrome and functional dyspepsia.MethodsA literature search was completed for preclinical and clinical studies related to central modulation of gastrointestinal functions and published in English between 1980 and 2006.ResultsExisting data, while sparse, support the use of different classes of antidepressant drugs, including tricyclics, and selective and non‐selective serotonin reuptake inhibitors in irritable bowel syndrome. Serotonin receptor agonists and antagonists with peripheral and possibly central effects are effective in treating specific subtypes of irritable bowel syndrome. Based largely on theoretical and preclinical evidence, several novel compounds that selectively target receptors at multiple levels within the brain–gut axis such as neurokinin, somatostatin and corticotropin‐releasing factor receptor antagonists are promising.ConclusionsThis review discusses the rationale for modulation of the brain–gut axis in the treatment of functional gastrointestinal disorders and highlights the most promising current and future therapeutic strategies.

The Brain-Gut Axis: From Pathophysiology to Possible Future Strategies of Treatment

“…Although convincing clinical trials supporting the efficacy of these drugs are still lacking, the effectiveness of antidepressants (tricyclics and SSRI), anxyolitics and sedatives might be related to sleep restoration and pain improvement, anticholinergic effects, normalization of gastrointestinal transit, fundic relaxation and peripheral antineuropathic effects, not only to frequent psychiatric comorbidities in such patients. In agreement with recent studies, amytriptiline, desipramine, citalopram, fluoxetine and paroxetine are the mostly administered drugs in IBS, with a potentially effective role of serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine [39].…”

Gut Microbiota Dysfunction as Reliable Non-invasive Early Diagnostic Biomarkers in the Pathophysiology of Parkinson's Disease: A Critical Review

“…22,23 This axis is responsible for the modulation of digestive process, immune function, perception and emotional response to visceral stimuli under physiological conditions. 24 Various diseases like anxiety and depressive disorders, liver diseases, gut inflammation, disorders of GI motility, and chronic abdominal pain syndrome, etc, are believed to occur due to dysregulation in the microbiota-gut-brain axis. 22,[25][26][27][28][29][30][31] This axis incorporates the CNS, autonomic nervous system, and enteric nervous system in addition to the neuroendocrine and the neuroimmune systems.…”

“…105 Microbiota changes are linked with alterations in intestinal barrier in GI diseases like irritable bowel syndrome. 24 Also colonic specimens of PD patients show downregulation of occluding. 95 Objective measures of PD include leukocyte subset counts, 106 serum cortisol, TNF-a, 107,108 in addition to global motor scores in the peripheral blood mononuclear cell production of cytokines, and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) expression.…”

Infection-induced viscerosensory signals from the gut enhance anxiety: Implications for psychoneuroimmunology

“…Factors previously associated with the development or risk of such symptoms, (e.g. pre-existing psychiatric disorder, somatosizing personality, stress and pain associated the illness) have generally been conceptualized from the top-down perspective, as have many new therapeutic approaches (Mayer et al 2006). However, if viscerosensory drive via the vagus contributes to affective symptoms in these disorders, interventions addressing underlying infection or inflammation, or other source of stimuli activating the vagus, could also ameliorate symptoms.…”