Gutbrainandbraingutinterconnectednessandwhatitcantellusaboutassociationbetween

psychiatricillnessandfunctionalGIdisordersobservedformanydecadesbutmechanisms
anddirectionalityarestillunderresearch
2015reviewarticlefromAustraliangroupdiscussesthis,focusingonmicrobialenvtofgutand
impactofearlytraumaonbraingutcommunication.
Bidirectionality:
o 12yrprospectivestudy:anxietyanddepressionpredictonsetofFGIDat12yrandvice
versaFGIDpredictsonsetofanxiety/depression
o 5yrf/ustudyfromUK:ofpatientswhorecordedaFGIDandamooddiagnosisover
thecourseofthe5years,twothirdshadapsychologicaldiagnosisfirst,versusonethird
havingaFGIDdiagnosisfirst
Braingut:
o ANSregulatesENS.Anxiety/depressionincreasedsympathetictone,decreased
parasympathetictone,whichaltergutmotility,secretionandimmunefunction
Noradrenalinerapidbacterialgrowthandtranslocationintogutwallmore
inflammation
o HPAaxisupregulationCRFdirectlyincreasesGImotility,secretionandsensitivity.
CRFupregulatedinIBSandstressstates.Cortisolmediatesinflammation/cytokines
downstreamwhichaffectGIfunctionandmicrobialenvt.
o responsivenessofmanyFGIDtobrainorientatedtherapieslikeCBT,alteredsensitivity
torectaldistensioninIBSsufferersthatimproveswiththerapyorantidepressants
Gutbrain:
o infectionleadstoexcessiveTNFandothercytokineproductioninvulnerable
individuals.TNFcausesanxietyinanimalsanddepressioninhumans
fitswithdysbiosistheory(gutfloraalteration)ofIBS
independentfromknowndetrimentaleffectofchronicillnessonsenseofself,
relationships,andlifestyle
resultinginflammationfrominfectioncanaffectabsorptionofneuroactive
substancesproducedbybacteria,bacterialtranslocationintogutwall,and
releaseofserotoninbyGIneuroendocrinecells,increasedperipheralpain
sensitivity
inflammcytokinescanaffectneurogenesisandneuronbranchingin
hippocampus
Earlytraumaandbraingutaxis
o Maternalseparationmodelsinmicehavedemonstratednotonlybehaviouraland
neurochemicalchanges,butalsosomereversalfromprobioticuse.Miceseparatedfrom
moms3hrs/day,forcedswimtesttomeasuredespair,Bifidobacteriuminfantis(a
probioticusedinIBS)normalisationofnoradrenalineinthebrainstemandperipheral
IL6levels,andimprovementsintheforcedswimtest
Whysignificant?
o AuthorshypothesizethatIBSismorecommonlyaresultofabraingutdisorderrather
thangutbrain(maybesimilarpatternsinotherFGIDs),anddistinguishingbetween
thesegroupswouldhavetherapeuticimplicationsandmayexplainwhyonlyasubset
withIBSforexamplerespondtopsychologicalinterventionsorantidepressantsand
othersareresistant

o Patientsaremoreamenabletotakedietary/probiotictherapythanpsychiatric
treatments,somoreresearchisneededtodetermineifsuchtreatmentscouldprevent
progressionofFGIDandanxiety/depression