The putative role of the intestinal microbiota in the irritable bowel syndrome
The putative role of the intestinal microbiota in the irritable bowel syndrome
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DOI：
10.1016/j.dld.2009.07.023
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发表时间：
2009-12-01
影响因子：
4.5
通讯作者：
Bercik, P.
中科院分区：
文献类型：
--
作者：
Collins, S. M.;Denou, E.;Bercik, P.
肠易激综合征（IBS）是一种慢性腹部综合征，其临床表现和潜在的病理生理学和发病机制是异质性的。现在已经确定，肠道感染可以在至少一部分患者中引发该综合征。此外，越来越多的证据表明，在一些IBS患者的远端肠道中存在低度炎症和免疫激活。这些观察结果现在引发了一个问题：是什么维持了这些患者的肠道功能障碍。肠道微生物群影响包括肠道和大脑在内的广泛的宿主器官，并且是这些系统中正常功能的重要决定因素。宿主与其肠道微生物群之间的微妙平衡的破坏（称为生态失调）导致粘膜免疫系统的变化，其范围从克罗恩病中所见的明显炎症到IBS患者亚组中所见的无组织损伤的低度炎症。在实验条件下，微生物群的破坏也会引起肠道感觉运动功能和免疫活性的变化。因此，由感染、饮食改变或抗生素等药物引起的生态失调可能会产生低度炎症和慢性肠道功能障碍，这让人想起在IBS中看到的情况。肠道生理学的波动破坏了肠道细菌的栖息地，并为慢性生态失调提供了基础。最近在动物模型中观察到肠道植物群的变化影响行为，这为一种新的统一假设提供了基础，该假设适应了许多IBS患者特有的肠道功能障碍和行为变化。该假说指出，由于感染、饮食改变或药物，至少在一部分IBS患者中存在生态失调，并且除了精神共病之外，还导致肠道炎症和功能变化。(C)2009 Editrice Gastroenterology Italiana S.r.l.由爱思唯尔有限公司出版。保留所有权利。
The irritable bowel syndrome (IBS) is a chronic abdominal symptom complex that is heterogeneous in terms of its clinical presentation and underlying pathophysiology, and pathogenesis. It is now established that enteric infection can trigger the syndrome in at least a subset of patients. In addition, there is growing evidence of low grade inflammation and immune activation in the distal bowel of some IBS patients. These observations now prompt the question as to what maintains gut dysfunction in these patients. The intestinal microbiota influences a broad array of host organs that include the gut and the brain, and is an important determinant of normal function in these systems. Disruption of the delicate balance between the host and its intestinal microbiota (termed dysbiosis) results in changes in the mucosal immune system that range from overt inflammation as seen in Crohn's Disease, to low grade inflammation without tissue injury, as seen in a subset of IBS patients. Under experimental conditions, disruption of the microbiota also produces changes in gut sensory-motor function and immune activity. Thus, dysbiosis induced by infection, dietary change or drugs such as antibiotics could produce low grade inflammation and chronic gut dysfunction, reminiscent of that seen in IBS. Fluctuations in gut physiology destabilize the habitat of commensal bacteria and provide a basis for chronic dysbiosis. Recent observations in animal models that changes in gut flora influence behavior provide a basis for a novel unifying hypothesis that accommodates both gut dysfunction and behavioral changes that characterize many IBS patients. This hypothesis states that dysbiosis exists in at least a subset of IBS patients, as a result of infection, dietary change or drugs and contributes to gut inflammatory and functional change in addition to psychiatric co-morbidity. (C) 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.