Mucosal neuroimmune mechanisms in gastro-oesophageal reflux disease (GORD) pathogenesis.

IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastroenterology Pub Date : 2024-03-01 Epub Date: 2024-01-14 DOI:10.1007/s00535-023-02065-9
Tom Leech, Madusha Peiris
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Abstract

Gastro-oesophageal reflux disease (GORD) is a chronic condition characterised by visceral pain in the distal oesophagus. The current first-line treatment for GORD is proton pump inhibitors (PPIs), however, PPIs are ineffective in a large cohort of patients and long-term use may have adverse effects. Emerging evidence suggests that nerve fibre number and location are likely to play interrelated roles in nociception in the oesophagus of GORD patients. Simultaneously, alterations in cells of the oesophageal mucosa, namely epithelial cells, mast cells, dendritic cells, and T lymphocytes, have been a focus of GORD research for several years. The oesophagus of GORD patients exhibits both macro- and micro-inflammation as a response to chronic acidic reflux at the epithelium. In other conditions of the GI tract, such as IBS and IBD, well-characterised bidirectional processes between immune cells and mucosal nerve fibres contribute to pathogenesis and symptom generation. Sensory alterations in these conditions such as nerve fibre outgrowth and hypersensitivity can be driven by inflammatory processes, which promote visceral pain signalling. This review will examine what is currently known of the molecular pathways linking inflammation and sensory perception leading to the development of GORD symptoms and explore potentially relevant mechanisms in other GI regions which may indicate new areas in GORD research.

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胃食管反流病(GORD)发病机制中的粘膜神经免疫机制。
胃食管反流病(GORD)是一种以食道远端内脏疼痛为特征的慢性疾病。目前治疗胃食管反流病的一线药物是质子泵抑制剂(PPIs),然而,PPIs 对大量患者无效,而且长期使用可能会产生不良影响。新的证据表明,神经纤维的数量和位置可能在 GORD 患者食道的痛觉中发挥着相互关联的作用。与此同时,食管黏膜细胞,即上皮细胞、肥大细胞、树突状细胞和 T 淋巴细胞的变化也是多年来 GORD 研究的重点。胃食管反流患者的食道上皮细胞因长期酸性反流而出现宏观和微观炎症反应。在肠易激综合征和肠易激综合征等其他消化道疾病中,免疫细胞和粘膜神经纤维之间特征明显的双向过程是发病机制和症状产生的原因。这些病症中的感官改变,如神经纤维增生和超敏性,可由炎症过程驱动,从而促进内脏疼痛信号传导。本综述将研究目前已知的连接炎症和感官知觉导致胃食管反流症状发生的分子途径,并探讨其他消化道区域的潜在相关机制,这些机制可能预示着胃食管反流研究的新领域。
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来源期刊
Journal of Gastroenterology
Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
12.20
自引率
1.60%
发文量
99
审稿时长
4-8 weeks
期刊介绍: The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.
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