Special Reports and ReviewsBrain-gut axis in health and disease☆
Section snippets
Review of the anatomy and physiology of the brain-gut axis
Gut function is modulated by both extrinsic and intrinsic neural pathways.20, 21, 22 The intrinsic innervation is provided by neurons of the myenteric and the submucous plexi, and the extrinsic innervation is provided by the splanchnic “sympathetic” and vagal-sacral “parasympathetic” nerves (Figure 1). The proximal esophagus22,
Clinical investigation of the human brain-gut axis
It is evident from the information given above that the GI tract is intricately connected to the CNS by pathways that are continuously sampling and modulating gut function. However, relatively little is known of the role played by these pathways in humans, and consequently the relation between the CNS and the development of GI dysfunction is incompletely understood. Recently, a number of noninvasive techniques have become available to assess brain-gut interactions, allowing progress to be made.
Future directions for GI research using functional brain imaging
So far, functional brain imaging techniques have only been used to study the proximal and the distal gut, because these regions are most readily accessible and receive a relatively strong modulatory influence from the brain. Nevertheless, appropriate stimulation of other gut organs also generates sensation,155 which makes it likely that these gut regions also receive cortical representation identifiable by the use of functional brain imaging techniques. It is possible therefore that future
Conclusion
Gastroenterologists are now provided with major opportunities to explore the CNS control of gut function using a series of new, powerful techniques. However, the availability of this new technology cannot alone advance knowledge, which will only occur if the technology is used appropriately to answer carefully considered biological questions, because they contain many technical traps for the unwary clinician. For advance to come, gastroenterologists will need to work in close collaboration with
Acknowledgements
The authors thank the following colleagues for contribution during the preparation of this manuscript: Dr. P. Enck, University of Düsseldorf, Germany; Dr. S. Hamdy, University of Manchester, England; P. L. Furlong, Department of Vision Sciences, Aston University, Birmingham, England; Dr. J. C. Rothwell, MRC Unit, Institute of Neurology, London, England; Dr. K. Singh, Royal Holloway Hospital, London, England; and S. Larkin, Computing Department, University of Manchester, England.
References (155)
- et al.
Brain stem tumor presenting as upper gut motility disorder
Gastroenterology
(1985) - et al.
Effect of traumatic spinal cord transection on human upper gastrointestinal motility and gastric emptying
Gastroenterology
(1984) - et al.
Clinical electroencephalography and event-related potentials
- et al.
Magnetoencephalography and magnetic source imaging
- et al.
Comparative anatomy of the oesophagus
Gastroenterology
(1974) Vagal afferent innervation of the gastrointestinal tract
Prog Brain Res
(1986)- et al.
Vagal afferent modulation of nociception
Brain Res Rev
(1992) - et al.
Basic and clinical aspects of visceral hyperalgesia
Gastroenterology
(1994) - et al.
Longitudinal columnar organization within the dorsal motor nucleus represents separate branches of the abdominal vagus
Brain Res
(1985) Central connections of the sensory and motor nuclei of the vagus nerve
J Auton Nerv Syst
(1983)
Projections of the nucleus of the solitary tract in the rat
Neuroscience
Viscerosomatic convergence on T-T spinoreticular, spinoreticular-spinothalamic and spinothalamic tract neurons in the cat
Exp Neurol
Role of visceral afferent mechanisms in functional bowel disorders
Gastroenterology
Input to the swallowing medullary neurons from the peripheral afferent fibres and the swallowing cortical area
Brain Res
Onuf's nucleus of the sacral cord in a South American monkey (Saimiri): its location and bilateral cortical input from area 4
Brain Res
Contralateral termination of pudendal nerve fibers in the gracile nucleus of the rat
Neurosci Lett
Brain electrical activity mapping: issues and answers
Cerebral responses evoked by electrical stimulation of the esophagus in normal subjects
Gastroenterology
The distribution of spinal and vagal sensory neurons that innervate the esophagus of the cat
Gastroenterology
Cerebral electrical potentials evoked by balloon distention of the human esophagus
Gastroenterology
Source modeling of esophageal evoked potentials
Electroencephalogr Clin Neurophysiol
Topographic mapping of cortical potentials evoked by distension of the human proximal and distal oesophagus
Electroencephalog Clin Neurophysiol
Historical perspectives of functional bowel disease
Experiments and observations on the gastric juice and the physiology of digestion
The work of digestive glands
The influence of emotional states on the functions of the alimentary canal
Am J Med Sci
Human gastric function: an experimental study of a man and his stomach
Effects of psychological factors on gastrointestinal function
Psychological factors in the irritable bowel syndrome
Gut
Stress and digestive motility. Section II. Experimental approach in humans
Dysphagia in acute stroke
Br Med J
Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves
Br J Surg
Patterns of small intestinal motility in duodenal ulcer patients before and following vagotomy
Gut
Functional brain imaging studies of cortical mechanisms for memory
Science
Illusory memories: a cognitive neuroscience analysis
Proc Natl Acad Sci USA
PET, CT and MRI in the evaluation of neuropsychiatric disorders: current applications
J Nucl Med
Magnetic source imaging in neurosurgical practice
Perspect Neurol Surg
Control centers in the central nervous system for regulating gastrointestinal motility
Extrinsic autonomic control of human gastrointestinal transit
Extrinsic control of digestive tract motility
Neuroanatomy of the striated muscular anal continence mechanisms. Implications for the use of neurostimulation
Dis Colon Rectum
The enteric nervous system
The enteric nervous system
Annu Rev Neurosci
Physiology of enteric neurons
The enteric nervous system
Am J Gastroenterol
Gastrointestinal afferent fibres and sensation
Vagal afferent fibres
Ergeb Physiol Biol Chem Exp Pharmacol
Viscerotopic representation of the upper alimentary tract in the rat: sensory ganglia and nuclei of the solitary and spinal trigeminal tracts
J Comp Neurol
Viscerotopic representation of the alimentary tract in the dorsal and ventral vagal complexes in the rat
Characteristics of vagal esophageal tension—sensitive afferent fibres in the opossum
J Neurophysiol
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Address requests for reprints to: David G. Thompson, M.D., Department of Medicine, Hope Hospital, Stott Lane, Salford M6 8HD, England. e-mail: [email protected]; fax: (44) 161-787-7432.