Gastroenterology

Gastroenterology

Volume 114, Issue 3, March 1998, Pages 559-578
Gastroenterology

Special Reports and Reviews
Brain-gut axis in health and disease

https://doi.org/10.1016/S0016-5085(98)70540-2Get rights and content

Abstract

GASTROENTEROLOGY 1998;114:559-578

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).

. Schematic representation of the intrinsic and extrinsic innervation of the smooth muscle region of the gut shows dual extrinsic innervation via vagal and spinal pathways.

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.

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