REVIEWS IN BASIC AND CLINICAL GASTROENTEROLOGY Neuroimaging of the Brain-Gut Axis: From Basic Understanding to Treatment of Functional GI Disorders
REVIEWS IN BASIC AND CLINICAL GASTROENTEROLOGY Neuroimaging of the Brain-Gut Axis: From Basic Understanding to Treatment of Functional GI Disorders
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发表时间：
2006
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通讯作者：
E. Mayer;David C. Metz;W. El-Deiry;Anil K Rustgi
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作者：
E. Mayer;David C. Metz;W. El-Deiry;Anil K Rustgi
脑-肠轴内的反射和感知反应改变已成为解释功能性胃肠道（GI）综合征主要症状的普遍接受的模型。用各种神经成像方式对活体人脑进行成像的能力大大提高了我们研究健康和疾病中这些脑肠道相互作用的能力。脑-肠轴内的反射反应由I层和迷走神经传入以及自主神经系统的传出介导，在由食物摄入、收缩活动和肠道植物群的代谢产物引起的生理扰动期间在维持内稳态中起关键作用。岛叶皮层在意识感知身体产生的所有感觉中起着重要作用，而背侧前扣带皮层（dACC）与效应器系统相连，介导情感反应和动机驱动。这些过程的幅度和增益受到中枢唤醒系统和自上而下的皮质边缘调制的高度影响，介导环境背景，情绪，认知和记忆对感知和肠道功能的影响。人类脑肠轴的大多数神经影像学研究与小脑前扣带回和前扣带回中传入信息的平行处理模型一致。较新的假设驱动的研究，研究传入输入，中枢唤醒系统和皮质边缘脑桥相互作用的差异贡献，极大地促进了我们对健康和疾病中脑肠道相互作用的理解。通过药理学和行为疗法，fMRI介导的检测参与这些不同过程的脑区域的活动和连接性的变化，为开发治疗功能性胃肠道疾病的新方法带来了巨大的希望。
Altered reflex and perceptual responses within the brain-gut axis have emerged as a generally accepted model to explain the cardinal symptoms of functional gastrointestinal (GI) syndromes. The ability to image the living human brain with various neuroimaging modalities has greatly enhanced our ability to study these brain gut interactions in health and disease. Reflex responses within the brain-gut axis, mediated by lamina I and vagal afferents, and efferents of the autonomic nervous system, play a crucial role in the maintenance of homeostasis during physiological perturbations caused by food intake, contractile activity, and metabolic products of the enteric flora. The insular cortex plays an important role in the conscious perception of all sensations arising from the body, while the dorsal anterior cingulate cortex (dACC), with its connection to effector systems, mediates the affective response and motivational drive. The magnitude and gain of these processes is highly influenced by central arousal systems and top-down corticolimbic modulation, mediating the effect of environmental context, emotions, cognitions, and memories on perception and gut function. The majority of neuroimaging studies of the brain gut axis in humans are consistent with the model of parallel processing of afferent information in insula and dACC. Newer hypothesis driven studies, studying the differential contributions of afferent input, central arousal systems, and cortico-limbic pontine interactions have greatly contributed to our understanding of brain gut interactions in health and disease. fMRI‐mediated detection of changes in the activity and connectivity of brain regions involved in these different processes by pharmacological and behavioral therapies holds great promise for the development of novel approaches to functional GI disorders.