Alterations of sensori-motor functions of the digestive tract in the pathophysiology of irritable bowel syndrome

• Published in: Baillière's best practice & research. Clinical gastroenterology Vol. 18; no. 4; pp. 747 - 771
• Main Author: Delvaux, Michel
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2004; Elsevier Limited
• Subjects: Abdomen; Animals; barostat; brain imaging; Central Nervous System - physiopathology; Clinical medicine; digestive motility; distension tests; enteric nervous system; Enteric Nervous System - physiopathology; Gastrointestinal Agents - pharmacology; Gastrointestinal Motility - drug effects; Gastrointestinal Motility - physiology; Humans; Irritable bowel syndrome; Irritable Bowel Syndrome - drug therapy; Irritable Bowel Syndrome - physiopathology; Manometry; Motility; motor profiles; Studies; visceral hypersensitivity; brain imaging; manometry; distension tests; irritable bowel syndrome; motor profiles; barostat; enteric nervous system; digestive motility; visceral hypersensitivity
• ISSN: 1521-6918; 1532-1916
• DOI: 10.1016/j.bpg.2004.06.004

Pathophysiology of irritable bowel syndrome (IBS) is based upon multiple factors that have been organised in a comprehensive model centred around the brain–gut axis. The brain–gut axis encompasses nerve pathways linking the enteric and the central nervous systems and contains a large proportion of afferent fibres. Functionally and anatomically, visceral nerves are divided in to two categories: the parasympathetic pathways distributing to the upper gut through the vagi and to the hindgut, through the pelvic and pudendal nerves, and the sympathetic pathways, arising form the spinal cord and distributing to the midgut via the paravertebral ganglia. Several abnormalities of gut sensori-motor function have been described in patients with IBS. Abnormal motility patterns have been described at the intestinal and colonic levels. Changes in colonic motility are mainly related to bowel disturbances linked to IBS but do not correlate with pain. More recently, visceral hypersensitivity has been recognised as a main characteristic of patients with IBS. It is defined by an exaggerated perception of luminal distension of various segments of the gut and related to peripheral changes in the processing of visceral sensations as well as modulation of perception by centrally acting factors including mood and stress. Viscero-visceral reflexes link the two edges of the brain–gut axis and may account for the origin of symptoms in some pathological conditions. Recent advances in the understanding of the role of myenteric plexus allowed recognition of several neurotransmitters involved at the level of both the afferent and efferent pathways. Targeting the receptors of these neurotransmitters is a promising way for development of new treatments for IBS.