Clinical and Experimental Medical Journal
Volume/Issue:
Volume 3: Issue 1
Neurological and psychiatric aspects of some gastrointestinal diseases
Author:
Zsuzsa Aszalós 2nd Department of Internal Medicine, Faculty of Medicine, Semmelweis University Medical School, Budapest, Hungary
Szentkirályi u. 46, H-1088, Budapest, Hungary

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Pages:
53–64
Online Publication Date:
01 Mar 2009
Publication Date:
01 Mar 2009
Article Category:
Review Article
DOI:
https://doi.org/10.1556/CEMED.3.2009.28480
Keywords:
brain-gut axis; enteric nervous system; irritable bowel syndrome; inflammatory bowel disease; celiac disease; 5-HT, serotonin; ACC, anterior cingulated cortex; ACh, acetylcholine; CGRP, calcitonin gene-related polypeptide; CNS, central nervous system; CRH, corticotrop release hormone; ENS, enteric nervous system; fMRI, functional magnetic resonance imaging; GI, gastrointestinal; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; MCC, middle cingulate cortex; pACC, perigenual anterior cingulated cortex; PAG, periaqueductal grey; PCC, posterior cingulated cortex; PFC, prefrontal cortex; sACC, supragenual anterior cingulated cortex; SSRI, selective serotonin reuptake inhibitor; TNFα, tumor necrosis factor-α; VIP, vasoactive intestinal peptide
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Abstract

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.

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Cover Clinical and Experimental Medical Journal
Clinical and Experimental Medical Journal
Print ISSN:
2060-6249
Online ISSN:
2060-968X

Clinical and Experimental Medical Journal
Language English
Size  
Year of
Foundation		 2007
Publication
Programme		 ceased
Volumes
per Year		  
Issues
per Year		  
Publisher Akadémiai Kiadó
Publisher's
Address		 H-1117 Budapest, Hungary 1516 Budapest, PO Box 245
Responsible
Publisher		 Chief Executive Officer, Akadémiai Kiadó
ISSN 2060-6249 (Print)
ISSN 2060-968X (Online)

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