肠-大脑相互作用障碍中的食后症状及其作为治疗点的潜力
Alexander C Ford1, Heidi M Staudacher2, Nicholas J Talley3
1Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK alexford@nhs.net.
Gut
|May 2, 2024
概括
功能性消化不良 (FD) 和刺激性肠综合征 (IBS) 的食后症状可能源于对食物抗原的免疫反应. 针对这些免疫路径可以改善这些常见肠道疾病的治疗结果.
科学领域:
- 胃肠道学和免疫学
- 肠-大脑相互作用的障碍
背景情况:
- 吃饭后的症状,如疼痛,胀气和早满,在功能性消化不良 (FD) 和刺激性肠综合征 (IBS) 中很常见.
- 这些症状可能源于一种独特的病理生理过程,涉及对食物抗原的免疫反应.
- 以前的侮辱,如感染,可以导致口服食物耐受性丧失,引发局部免疫反应.
研究的目的:
- 为FD和IBS中食后症状提出一个独特的病理生理过程.
- 探索食物抗原和免疫激活在这些症状中的作用.
- 根据本拟议的机制,评估潜在的治疗目标.
主要方法:
- 对FD和IBS中食后症状的病理生理学现有文献的综述.
- 分析涉及免疫激活,炎症媒介和神经信号的拟议机制.
- 对针对这些机制的饮食和药理干预措施的评估.
主要成果:
- 与肠道微生物群和免疫系统相互作用的食物抗原可以导致局部炎症 (乙酸性细胞,巨细胞) 并释放诸如组胺和细胞因子等介质.
- 这些介质可以触发感应神经,影响情绪,导致全身症状.
- 饮食干预 (低FODMAP,抗原消除) 和药物 (PPI,H2抗剂,巨细胞稳定剂,抗抑郁药) 可能调节这些途径.
结论:
- 驱动免疫反应的食物抗原可能解释FD和IBS患者的一个子集的食后症状.
- 这种范式转变表明,针对免疫机制的治疗可以改善患者的治疗结果.
- 其他机制,如碳水化合物发酵,食品化学反应,中心因素,或nocebo效应也可能有助于不同的患者.
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