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Gastrointestinal dysfunction in neuroinflammatory diseases: Multiple sclerosis, neuromyelitis optica, acute autonomic ganglionopathy and related conditions
Autonomic Neuroscience ( IF 3.2 ) Pub Date : 2021-03-13 , DOI: 10.1016/j.autneu.2021.102795
Ryuji Sakakibara 1
Affiliation  

Disorders of the nervous system can produce a variety of gastrointestinal (GI) dysfunctions. Among these, lesions in various brain structures can cause appetite loss (hypothalamus), decreased peristalsis (presumably the basal ganglia, pontine defecation center/Barrington's nucleus), decreased abdominal strain (presumably parabrachial nucleus/Kolliker-Fuse nucleus) and hiccupping and vomiting (area postrema/dorsal vagal complex). In addition, decreased peristalsis with/without loss of bowel sensation can be caused by lesions of the spinal long tracts and the intermediolateral nucleus or of the peripheral nerves and myenteric plexus.

Recently, neural diseases of inflammatory etiology, particularly those affecting the PNS, are being recognized to contribute to GI dysfunction. Here, we review neuroinflammatory diseases that potentially cause GI dysfunction. Among such CNS diseases are multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein associated disorder, and autoimmune encephalitis. Peripheral nervous system diseases impacting the gut include Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, acute sensory-autonomic neuropathy/acute motor-sensory-autonomic neuropathy, acute autonomic ganglionopathy, myasthenia gravis and acute autonomic neuropathy with paraneoplastic syndrome. Finally, collagen diseases, such as Sjogren syndrome and systemic sclerosis, and celiac disease affect both CNS and PNS.

These neuro-associated GI dysfunctions may predate or present concurrently with brain, spinal cord or peripheral nerve dysfunction. Such patients may visit gastroenterologists or physicians first, before the neurological diagnosis is made. Therefore, awareness of these phenomena among general practitioners and collaboration between gastroenterologists and neurologists are highly recommended in order for their early diagnosis and optimal management, as well as for systematic documentation of their presentations and treatment.



中文翻译:

神经炎症性疾病中的胃肠功能障碍:多发性硬化症、视神经脊髓炎、急性自主神经节病和相关疾病

神经系统疾病可导致多种胃肠道 (GI) 功能障碍。其中,大脑各种结构的病变可导致食欲减退(下丘脑)、蠕动减弱(可能是基底神经节、脑桥排便中枢/巴林顿核)、腹部应变减弱(可能是臂旁核/Kolliker-Fuse核)和打嗝和呕吐(区域后部/背侧迷走神经复合体)。此外,伴有/不伴有肠感觉丧失的蠕动减少可由脊髓长束和中间外侧核或周围神经和肌间神经丛的病变引起。

最近,炎症病因的神经疾病,特别是影响 PNS 的神经疾病,被认为会导致 GI 功能障碍。在这里,我们回顾了可能导致胃肠道功能障碍的神经炎症性疾病。此类中枢神经系统疾病包括多发性硬化症、视神经脊髓炎谱系疾病、髓鞘少突胶质细胞糖蛋白相关疾病和自身免疫性脑炎。影响肠道的周围神经系统疾病包括格林-巴利综合征、慢性炎性脱髓鞘性多发性神经病、急性感觉-自主神经病/急性运动-感觉-自主神经病、急性自主神经节病、重症肌无力和伴有副肿瘤综合征的急性自主神经病。最后,胶原蛋白疾病,如干燥综合征和系统性硬化症,以及腹腔疾病会影响 CNS 和 PNS。

这些神经相关的胃肠道功能障碍可能早于或与脑、脊髓或周围神经功能障碍同时出现。在做出神经学诊断之前,这些患者可能会先去看胃肠病学家或医生。因此,强烈建议全科医生了解这些现象以及胃肠病学家和神经病学家之间的合作,以便对他们进行早期诊断和优化管理,并系统地记录他们的表现和治疗。

更新日期:2021-03-17
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