The gastrointestinal tract is controlled by the independent enteric nervous system. It is also closely connected to the central nervous system and bi-directional communication exists between them. The communication involves neural pathways as well as immune and endocrine mechanisms. The brain-gut axis plays a prominent role in the modulation of gut functions. Signals from different sources (e. g. sound, sight, smell, somatic and visceral sensations, pain) reach the brain. These inputs are modified by memory, cognition and affective mechanisms and integrated within the neural circuits of the central nervous system, spinal cord, autonomic and enteral nervous systems. These inputs can have physiologic effects, such as changes in motility, secretion, immune function, and blood flow to the gastrointestinal tract. One of the most important neurotransmitter is serotonin that plays a key role in the pathogenesis of the most common chronic functional gastrointestinal disorder: the irritable bowel syndrome. It is a biopsychosocial disease, resulting from the dysregulation of the brain-gut axis. Endogenous pain facilitation rather than inhibition, pathologic gradation of visceral perception and reduced threshold for pain are all evident in these patients. Abuse history is common in their anamnesis. Exaggerated conscientiousness, perfectionism, oversensitivity, feeling of deficiency in effectiveness, and higher demand for social parity, neuroticism and alexithymia have been detected among their constant personality features. Females are also characterized by gender role conflict and low assertiveness. Antidepressants and psychotherapy have important roles in their treatment. Also patients with inflammatory bowel disease are characterized by neuroticism and alexythymia and altered mother-child attachment is often described in their anamnesis. Autonomic neuropathy is a frequent and early neurological complication. Reflux disease and obstructive sleep apnea mutually generate each another and their severities significantly correlate. In the celiac disease the most common neurological manifestations are ataxia, peripheral neuropathy and myopathy. Up to 85% of patients with histologically proven coeliac disease have no gastrointestinal symptoms; consequently, measurement of antigliadin antibody titre is vital in all cases of idiopathic ataxia. Complete resolution of neurological symptoms is the result of gluten-free diet.
. T. Mach 2004 The brain-gut axis in irritable bowel syndrome — clinical aspects Med. Sci. Monit. 10 RA125–131.
. J. D. Wood 2008 Enteric nervous system: reflexes, pattern generators and motility Curr. Opin. Gastroenterol. 24 149–158.
. M.P. Jones J.B. Dilley D. Drossman et al.2006 Brain-gut connections in functional GI disorders: anatomic and physiologic relationships Neurogastroenterol. Motil. 18 91–103.
. Y. Ringel D. A. Drossman J. L. Leserman et al.2008 Effect of abuse history on pain reports and brain responses to aversive visceral stimulation: an fMRI study Gastroenterology 134 396–404.
. A. Lawal M. Kern A. Sanjeevi et al.2005 Cingulate cortex: a closer look at its gut-related functional topography Am. J. Physiol. Gastrointest Liver Physiol. 289 G722–G730.
. E. A. Mayer S. Berman B. Suyenobu et al.2005 Differences in brain responses to visceral pain between patients with irritable bowel syndrome and ulcerative colitis Pain 115 398–409.
. I. Pregun L. Herszényi M. Juhász et al.2007 Az irritábilis bélszindróma kezelésének új lehetőségei Orv. Hetil. 148 923–928 (New possibilities in the treatment of irritable bowel syndrome.).
. N. J. Talley 2001 Serotoninergic neuroenteric modulators Lancet 358 2061–2068.
. M. Heitkemper M. Jarrett 2008 Irritable bowel syndrome: Does gender matter? J. Psychosom. Res. 64 583–587.
. C. H. Wilder-Smith J. Robert-Yap 2007 Abnormal endogenous pain modulation and somatic and visceral hypersensitivity in female patients with irritable bowel syndrome World J. Gastroenterol. 13 3699–3704.
. A. Lawal M. Kern H. Sidhu et al.2006 Novel evidence for hypersensitivity of visceral sensory neural circuitry in irritable bowel syndrome patients Gastroenterology 130 26–33.
. Király Cs. Csizmadia A. Illés et al.2006 The visceral hyperaesthesia in irritable bowel syndrome Orv. Hetil. 147 421–426.
. B. Spiegel P. Schoenfeld B. Naliboff 2007 The prevalence of suicidal behaviour in patients with chronic abdominal pain and irritable bowel syndrome Aliment. Pharmacol. Ther. 26 183–193.
. I. Posserud A. Ersryd M. Simrén 2006 Functional findings in irritable bowel syndrome World J. Gastroenterol. 12 2830–2838.
. N. J. Talley 2006 Irritable bowel syndrome Int. Med. J. 36 724–728.
. D. A. Drossman Y. Ringel B. A. Vogt et al.2003 Alterations of brain activity associated with resolution of emotional distress and pain in a case of severe irritable bowel syndrome Gastroenterology 124 754–761.
. V. Deary T. Chalder M. Sharpe 2007 The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review Clin. Psychol. Rev. 27 781–797.
. A. Halpert D. Drossman 2005 Biopsychosocial issues in irritable bowel syndrome J. Clin. Gastroenterol. 39 665–669.
. M.-J. Gerson C. D. Gerson R. A. Awad et al.2006 An international study of irritable bowel syndrome: Family relationships and mind-body attributions Social Sci. Med. 62 2838–2847.
. M. Kano T. Hamaguchi M. Itoh et al.2007 Correlation between alexithymia and hypersensitivity to visceral stimulation in human Pain 132 252–263.
. K. Hagymási Zs. Tulassay 2006 Az irritábilis bél szindróma genetikai háttere Orv. Hetil. 147 1167–1170 (Genetic background of the irritable bowel syndrome.).
. C. L. Woodman K. Breen R. Noyes Jr. et al.1998 The relationship between irritable syndrome and psychiatric illness Psychosomatics 39 45–54.
. M. J. Spence R. Moss-Morris 2007 The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis Gut 56 1066–1071.
. Z. Kovács F. Kovács 2007 Depression signs in irritable bowel syndrome and in inflammatory bowel disease Psychiat. Hung. 22 212–221.
. M. Williams A. Budavari K. W. Olden et al.2005 Psychosocial assessment of functional gastrointestinal disorders in clinical practice J. Clin. Gastroenterol. 39 847–857.
. J. Hutton 2005 Cognitive behaviour therapy for irritable bowel syndrome Eur. J. Gastroenterol. Hepatol. 17 11–14.
. J. Casati B. B. Toner 2000 Psychosocial aspects of inflammatory bowel disease Biomed. Pharmacother. 54 388–391.
. Z. Ranjbaran L. Keefer A. Farhadi et al.2007 Impact of sleep disturbances in inflammatory bowel disease J. Gastroenterol. Hepatol. 22 1748–1753.
. B. Moreno-Jiménez B. L. Blanco A. Rodríguez-Muñoz et al.2007 The influence of personality factors on health-related quality of life of patients with inflammatory bowel disease J. Psychosom. Res. 62 39–46.
. I. Lázár 1995 The psychoneuroimmunology of inflammatory bowel diseases Magy. Belorv. Arch. 5 335–341.
. A. A. Mikoczka-Walus D. A. Turnbull N. T. Moulding et al.2006 Antidepressants and inflammatory bowel disease: a systematic review Clin. Pract. Epidemiol. Mental Health 2 24.
. B. Ohlsson G. Sundkvist S. Lindgren 2007 Subclinical sympathetic neuropathy appears early in the course of Crohn's disease BMC Gastroenterol. 7 33.
. P. Diószeghy M. Molnár F. Mechler 1994 Izomkárosodás Crohn-betegségben Orv. Hetil. 135 1259–1261 (Muscular damage in Crohn's disease.).
. P. Demeter K. Váradi Visy P. Magyar 2004 The gastrooesophageal reflux disease and obstructive sleep apnoe Orv. Hetil. 145 1897–1901.
. E. D. Giudice 2007 Subclinical neurological involvement in treated celiac disease: a dark side of gluten-related encephalopathies J. Pediatr. Gastroenterol. Nutr. 45 290–292.
. M. Csaplár M. Juhász Gy. Műzes et al.2006 The association of coeliakia and myasthenia gravis Orv. Hetil. 147 841–844.
. M. Hadjivassiliou R. A. Grünewld A. K. Chattopadhyay et al.1998 Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia Lancet 352 1582–1585.
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