Therapeutic potential and mechanisms of sacral nerve stimulation for gastrointestinal diseases.
Therapeutic potential and mechanisms of sacral nerve stimulation for gastrointestinal diseases.
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DOI：
10.2478/jtim-2023-0086
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发表时间：
2023-07
影响因子：
4.9
通讯作者：
Chen, Jiande D. Z.
中科院分区：
文献类型：
--
作者：
Wang, Ximeng;Chen, Jiande D. Z.
关键词：
本文就骶神经刺激（SNS）治疗各种胃肠道疾病的临床应用（尤其是新兴的临床应用）和潜在机制作一系统综述。检索PubMed和Web of Science中发表的关于SNS及其在大便失禁（仅限于临床研究的系统综述和荟萃分析）、便秘（仅限于综述和随机对照临床研究）、肠易激综合征（IBS）、炎症性肠病（IBD）和上消化道动力障碍中的临床应用的研究。汇总了相关研究，并对其结果进行了总结和讨论。SNS是一种经批准的治疗大便失禁的方法。系统回顾和荟萃分析表明SNS治疗大便失禁的有效性高。据报道，SNS治疗的主要机制是肛门括约肌压力增加和直肠感觉改善。SNS也被提出用于治疗便秘，但该疗法已被证明无效。在SNS的方法优化和机制研究方面存在不足。一些基础和临床研究报道了SNS治疗IBS内脏痛的潜力。SNS似乎能够改善粘膜屏障功能。在SNS治疗IBD的文献中有几份病例报告。几项实验室研究表明SNS的特殊方法对IBD的治疗潜力。报道了胆碱能抗炎机制。由于最近报道了SNS的脊髓传入和迷走神经传出通路，一些临床前研究报道了SNS治疗上消化道动力障碍的潜力。然而，尚未进行临床研究。SNS治疗大便失禁是一种成熟的临床治疗方法。然而，目前的SNS方法对治疗便秘无效。需要进一步的方法学开发和随机临床试验来探索SNS在IBS和IBD中的潜在应用。
The aim of this systemtic review is to introduce clinical applications (especially emerging) and potential mechanisms of sacral nerve stimulation (SNS) for treating various gastrointestinal diseases. PubMed and Web of Science were searched for studies published on SNS and its clinical applications in fecal incontinence (limited to systematic review and meta-analysis of clinical studies), constipation (limited to reviews and randomized control clinical studies), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and upper gastrointestinal motility disorders. The relevant studies were pooled, and their findings were summarized and discussed. SNS is an approved method for treating fecal incontinence. Systematic review and meta-analysis demonstrated high efficacy of the SNS therapy for fecal incontinence. Increased anal sphincter pressure and improvement in rectal sensation were reported as major mechanisms involved in the SNS therapy. SNS has also been proposed for treating constipation, but the therapy has been shown ineffective. There is a lack in SNS methodological optimization and mechanistic research. A few basic and clinical studies have reported the potential of SNS for treating visceral pain in IBS. SNS seemed capable of improving mucosal barrier functions. Several case reports are available in the literature on the treatment of IBD with SNS. Several laboratory studies suggested therapeutic potential of a special method of SNS for IBD. Cholinergic anti-inflammatory mechanisms were reported. Due to a recently reported spinal afferent and vagal efferent pathway of SNS, a few preclinical studies reported the potential of SNS for upper gastrointestinal motility disorders. However, no clinical studies have been performed. SNS for fecal incontinence is a well-established clinical therapy. However, the current method of SNS is ineffective for treating constipation. Further methodological development and randomized clinical trials are needed to explore potential applications of SNS for IBS and IBD.
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影响因子：
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