Detection and Evaluation Methods of Visceral Sensitivity in Irritable Bowel Syndrome: a Review of the Latest Developments

doi:10.12114/j.issn.1007-9572.2022.0605

Abstract

Abstract:

Visceral hypersensitivity is one major pathophysiological characteristic of irritable bowel syndrome (IBS) , a common functional bowel disorder. The detection and evaluation of visceral hypersensitivity are of practical significance for the guidance of clinical diagnosis and treatment of IBS. We reviewed the latest studies on the detection and evaluation methods of visceral hypersensitivity mediated by both peripheral and central factors in IBS patients and animal models, and found some limitations in these studies such as monotonous evaluation methods, and limited applications of the methods. The possible applications of these methods in both animal experiments and clinical trials can be explored in future researches.

Key words: Irritable bowel syndrome, Visceral sensitivity, Colonic sensation, Peripheral sensitization, Central sensitization, Evaluating indicator, Literature review

摘要：

肠易激综合征（IBS）是临床上常见的功能性胃肠病，内脏敏感性增加是IBS重要的病理生理特征之一，对内脏敏感性的检测和评价对IBS临床诊断及治疗具有实际意义。本文通过检索、整理关于IBS内脏敏感性的研究，从中枢与外周两个角度出发，综述了对IBS患者和模型动物内脏敏感性增加状态的检测及评估方法，发现目前研究存在方法较单一、运用受限等问题。在未来的研究中，可以进一步探索各种评价方法在动物实验与人体试验中运用的可能性。

关键词: 肠易激综合征, 内脏敏感性, 结肠敏感性, 外周敏化, 中枢敏化, 评价指标, 文献综述

HOU Yujun,ZHAO Ying,JIANG Huiling, et al. Detection and Evaluation Methods of Visceral Sensitivity in Irritable Bowel Syndrome: a Review of the Latest Developments[J]. Chinese General Practice, 2023, 26(21): 2673-2677. DOI: 10.12114/j.issn.1007-9572.2022.0605.
侯雨君,赵映,蒋慧灵等. 肠易激综合征内脏敏感性检测与评价方法的研究进展[J]. 中国全科医学, 2023, 26(21): 2673-2677. DOI: 10.12114/j.issn.1007-9572.2022.0605.

References 36

[1]	LING X W, PENG S Y, ZHONG J B，et al. Effects of Chang-Kang-Fang formula on the microbiota-gut-brain axis in rats with irritable bowel syndrome[J]. Front Pharmacol，2022，13:778032. DOI：10.3389/fphar.2022.778032.
[2]	AL-CHAER E D, KAWASAKI M, PASRICHA P J. A new model of chronic visceral hypersensitivity in adult rats induced by colon irritation during postnatal development[J]. Gastroenterology，2000，119(5):1276-1285. DOI：10.1053/gast.2000.19576.
[3]	陈颖，赵妍，罗丹妮，等. 腹壁撤退反射实验测量方法概述[J]. 中国比较医学杂志，2017，27(8):89-93.
[4]	周瑾. 电针不同经穴对IBS模型大鼠ACC神经兀放电及结肠5-HT2A受体影响研究[D]. 北京：北京中医药大学，2016.
[5]	戚庆庆. 结肠N-甲基-D-天冬氨酸受体参与肠易激综合征内脏高敏感发病机制的研究[D]. 济南：山东大学，2016.
[6]	FAN F, TANG Y, DAI H F，et al. Blockade of BDNF signalling attenuates chronic visceral hypersensitivity in an IBS-like rat model[J]. Eur J Pain，2020，24(4):839-850. DOI：10.1002/ejp.1534.
[7]	DEITEREN A, DE MAN J G, KEATING C，et al. Mechanisms contributing to visceral hypersensitivity：focus on splanchnic afferent nerve signaling[J]. Neurogastroenterol Motil，2015，27(12):1709-1720. DOI：10.1111/nmo.12667.
[8]	HUGHES P A, HARRINGTON A M, CASTRO J，et al. Sensory neuro-immune interactions differ between irritable bowel syndrome subtypes[J]. Gut，2013，62(10):1456-1465. DOI：10.1136/gutjnl-2011-301856.
[9]	ELSENBRUCH S, ROSENBERGER C, ENCK P，et al. Affective disturbances modulate the neural processing of visceral pain stimuli in irritable bowel syndrome：an fMRI study[J]. Gut，2010，59(4):489-495. DOI：10.1136/gut.2008.175000.
[10]	ZHANG W X, ZHANG Y, QIN G，et al. Altered profiles of fecal metabolites correlate with visceral hypersensitivity and may contribute to symptom severity of diarrhea-predominant irritable bowel syndrome[J]. World J Gastroenterol，2019，25(43):6416-6429. DOI：10.3748/wjg.v25.i43.6416.
[11]	BOTHA C, FARMER A D, NILSSON M，et al. Preliminary report：modulation of parasympathetic nervous system tone influences oesophageal pain hypersensitivity[J]. Gut，2015，64(4):611-617. DOI：10.1136/gutjnl-2013-306698.
[12]	WINSTON J H, XU G Y, SARNA S K. Adrenergic stimulation mediates visceral hypersensitivity to colorectal distension following heterotypic chronic stress[J]. Gastroenterology，2010，138(1):294-304.e3. DOI：10.1053/j.gastro.2009.09.054.
[13]	李佳佳，任文静，尹海燕，等. 应激与肠道疾病发生机制[J]. 世界华人消化杂志，2020，28(14):617-627.
[14]	CHENG P, SHIH W, ALBERTO M，et al. Autonomic response to a visceral stressor is dysregulated in irritable bowel syndrome and correlates with duration of disease[J]. Neurogastroenterol Motil，2013，25(10):e650-659. DOI：10.1111/nmo.12177.
[15]	胡霞，陈坚义，吴松，等. 针灸对肠易激综合征大鼠心率变异性影响的实验研究[J]. 时珍国医国药，2021，32(1):226-229.
[16]	SALVIOLI B, PELLEGATTA G, MALACARNE M，et al. Autonomic nervous system dysregulation in irritable bowel syndrome[J]. Neurogastroenterol Motil，2015，27(3):423-430. DOI：10.1111/nmo.12512.
[17]	VAN ORSHOVEN N P, ANDRIESSE G I, VAN SCHELVEN L J，et al. Subtle involvement of the parasympathetic nervous system in patients with irritable bowel syndrome[J]. Clin Auton Res，2006，16(1):33-39. DOI：10.1007/s10286-006-0307-x.
[18]	官俏兵，张晓玲，阮水良，等. 自主神经功能检测在功能性肠病患者中的应用[J]. 中华物理医学与康复杂志，2012，34(7):544-545. DOI：10.3760/cma.j.issn.0254-1424.2012.07.019.
[19]	EDEBOL-CARLMAN H, SCHROOTEN M, LJÓTSSON B，et al. Cognitive behavioral therapy for irritable bowel syndrome：the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions-an uncontrolled trial[J]. Scand J Pain，2018，18(1):81-91. DOI：10.1515/sjpain-2017-0153.
[20]	TANAKA T, MANABE N, HATA J，et al. Characterization of autonomic dysfunction in patients with irritable bowel syndrome using fingertip blood flow[J]. Neurogastroenterol Motil，2008，20(5):498-504. DOI：10.1111/j.1365-2982.2007.01039.x.
[21]	MURRAY C D, FLYNN J, RATCLIFFE L，et al. Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome[J]. Gastroenterology，2004，127(6):1695-1703. DOI：10.1053/j.gastro.2004.08.057.
[22]	STASI C, BELLINI M, GAMBACCINI D，et al. Neuroendocrine dysregulation in irritable bowel syndrome patients：a pilot study[J]. J Neurogastroenterol Motil，2017，23(3):428-434. DOI：10.5056/jnm16155.
[23]	袁莉莉，余跃，蒋楠，等. 内脏高敏感模型大鼠结肠特异背根神经节神经元的形态学和兴奋性研究[J]. 安徽医科大学学报，2013，48(11):1300-1303. DOI：10.19405/j.cnki.issn1000-1492.2013.11.004.
[24]	ANAND P, AZIZ Q, WILLERT R，et al. Peripheral and central mechanisms of visceral sensitization in man[J]. Neurogastroenterol Motil，2007，19(1 Suppl):29-46. DOI：10.1111/j.1365-2982.2006.00873.x.
[25]	郭玉婷，李延青，左秀丽，等. 肠易激综合征内脏过敏大鼠脊髓诱发电位的研究[J]. 胃肠病学，2003，8(S1):15-16.
[26]	FAN Y, RYU Y, ZHAO R J，et al. Enhanced spinal neuronal responses as a mechanism for increased number and size of active acupoints in visceral hyperalgesia[J]. Sci Rep，2020，10(1):10312. DOI：10.1038/s41598-020-67242-9.
[27]	李凯歌. 电针对IBS大鼠VPL神经元放电及GalR1、c-kit和TRPV1的影响[D]. 北京：北京中医药大学，2017.
[28]	金玉，谭诗云. 肠易激综合征患者精神状态与脑电图改变的相关性研究[J]. 胃肠病学和肝病学杂志，2014，23(4):463-467. DOI：10.3969/j.issn.1006-5709.2014.04.031.
[29]	AREBI N, BULLAS D C, DUKES G E，et al. Distinct neurophysiological profiles in irritable bowel syndrome[J]. Am J Physiol Gastrointest Liver Physiol，2011，300(6):G1086-1093. DOI：10.1152/ajpgi.00553.2010.
[30]	郑寒丹，马喆，丁邦友，等. 脑功能成像技术在针灸治疗肠易激综合征中的应用[J]. 世界中医药，2018，13(9):2352-2356.
[31]	NISSEN T D, BROCK C, LYKKESFELDT J，et al. Pharmacological modulation of colorectal distension evoked potentials in conscious rats[J]. Neuropharmacology，2018，140:193-200. DOI：10.1016/j.neuropharm.2018.07.028.
[32]	COSS-ADAME E, RAO S S C. Brain and gut interactions in irritable bowel syndrome：new paradigms and new understandings[J]. Curr Gastroenterol Rep，2014，16(4):379. DOI：10.1007/s11894-014-0379-z.
[33]	PERNA E, AGUILERA-LIZARRAGA J, FLORENS M V，et al. Effect of resolvins on sensitisation of TRPV1 and visceral hypersensitivity in IBS[J]. Gut，2021，70(7):1275-1286. DOI：10.1136/gutjnl-2020-321530.
[34]	潘雨烟，毛心勇，刘倩，等. 基于"脑肠同调"治疗腹泻型肠易激综合征[J]. 中医杂志，2021，62(13):1130-1133,1143. DOI：10.13288/j.11-2166/r.2021.13.007.
[35]	郭静，孙建华，陈璐，等. 针刺双向调节效应——"调神健脾"法针刺治疗肠易激综合征多中心随机对照试验亚组分析[J]. 中国针灸，2021，41(8):845-850. DOI：10.13703/j.0255-2930.20201111-k0001.
[36]	CHEY W D, KURLANDER J, ESWARAN S. Irritable bowel syndrome：a clinical review[J]. JAMA，2015，313(9):949-958. DOI：10.1001/jama.2015.0954.