Beyin- Bağırsak Eksenine Odaklanan Yaklaşımlar Işığında İBS ve Migren

Beyin, sindirim kanalının duyu ve salgı işlevlerinin regülasyonunu sağlamakta, çeşitli hormonlar aracılığıyla bağırsak fonksiyonlarını düzenlemektedir. Öte yandan bilişsel ve davranışsal bazı beyin işlevlerinin de bağırsaklar ile etkileşim halinde olduğu düşünülmektedir. Son dönemlerde beyin ve bağırsaklar arasındaki çift yönlü iletişimin aydınlatılması sonucunda, İBS gibi fonksiyonel gastrointestinal bozuklukların, migren gibi diğer fonksiyonel bozukluklar ile ilişkili olabileceği düşünülmektedir. İBS ve migren, vücudun farklı bölgelerinde gözlendikleri halde; belirli organik sebeplerin yokluğunda meydana gelen, epizodik semptomlar ile tekrarlayan, epidemiyolojik dağılımları benzer olan hastalıklardır. Dahası, her iki hastalığın bağırsak mikrobiyotası ile ilişkisi, çeşitli çalışmalarda gösterilmiştir. Migren hastalarında İBS yaygınlığı, ataklar esnasında gözlenen GİS semptomları ve İBS hastalarında sıklıkla baş ağrısının bildirilmesi, migren ve İBS arasındaki potansiyel ilişkiyi destekler niteliktedir. Bu derlemede bağırsak- beyin eksenine odaklanan yaklaşımlar ile, İBS ve migrenin incelenmesi ve aralarındaki potansiyel bağlantının sorgulanması amaçlanmıştır. Beyin- bağırsak eksenine odaklanan yaklaşımların, fonksiyonel gastrointestinal hastalıklar başta olmak üzere, birçok hastalığın mekanizmalarının aydınlatılmasına ve tedavi planlarının oluşturulmasına katkısı olacağını düşünmekteyiz.

IBS and Migraine in The Light of Approaches Focusing on The Brain- Gut Axis

The brain regulates the sensory and secretory functions of the digestive tract and intestinal functions through various hormones. On the other hand, some cognitive and behavioral brain functions are thought to relate with the intestines. It is thought that functional gastrointestinal disorders such as IBS may be associated with other functional disorders such as migraine, as a result of the clarification of the bidirectional communication between the brain and the intestines. Although IBS and migraine are observed in different parts of the body; They are diseases that occur in the absence of certain organic causes, recur with episodic symptoms and have similar epidemiological distributions. Moreover, the association of both diseases with the gut microbiota has been demonstrated in several studies. The prevalance of IBS in migraine patients, GIS symptoms observed during attacks, and frequent reporting of headache in IBS patients support the potential relationship between migraine and IBS. In this review, it is aimed to examine IBS and migraine with approaches that focus on the gut-brain axis and to question the potential connection between them. In this way,we consider that it will contribute to the elucidation of the mechanisms of many diseases, especially functional gastrointestinal diseases, and to the planning of treatments.

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  • Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology. 2016: 150(6): 1393-1407. doi:10.1053/j.gastro.2016.02.031
  • Martin CR, Osadchiy V, Kalani A, Mayer EA. The brain-gut-microbiome axis. Cell Mol Gastroenterol Hepatol. 2018:6(2):133-148. doi:10.1016/j.jcmgh.2018.04.003
  • Arzani M, Jahromi SR, Ghorbani Z, et al. Gut-brain axis and migraine headache: a comprehensive review. J Headache Pain. 2020:21(1):15. doi:10.1186/s10194-020-1078-9
  • Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015:313(9):949-958. doi:10.1001/jama.2015.0954
  • Lucak S, Chang L, Halpert A, Harris LA. Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice. Therap Adv Gastroenterol. 2017:10(2):253-275. doi:10.1177/1756283X16663396
  • Wilkins T, Pepitone C, Alex B, Schade RR. Diagnosis and management of IBS in adults. Am Fam Physician. 2012:86(5):419-426.
  • Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012:10(7):712-721.e4. doi:10.1016/j.cgh.2012.02.029
  • Defrees DN, Bailey J. Irritable bowel syndrome: epidemiology, pathophysiology, diagnosis, and treatment. Prim Care. 2017:44(4):655-671. doi:10.1016/j.pop.2017.07.009
  • Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997:11(2):395-402. doi:10.1046/j.1365-2036.1997.142318000.x
  • Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011:106(5):915-922. doi:10.1038/ajg.2010.480
  • Chumpitazi BP, Weidler EM, Lu DY, Tsai CM, Shulman RJ. Self-perceived food ıntolerances are common and associated with clinical severity in childhood ırritable bowel syndrome. J Acad Nutr Diet. 2016:116(9):1458-1464. doi:10.1016/j.jand.2016.04.017
  • Spiller R, Aziz Q, Creed F, et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut. 2007:56(12):1770-1798. doi:10.1136/gut.2007.119446
  • Nanayakkara WS, Skidmore PM, O'Brien L, Wilkinson TJ, Gearry RB. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clin Exp Gastroenterol. 2016:9:131-142. doi:10.2147/CEG.S86798
  • Mearin F, Ciriza C, Mínguez M, et al. Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult. Rev Esp Enferm Dig. 2016:108(6):332-363. doi:10.17235/reed.2016.4389/2016
  • Moayyedi P, Andrews CN, MacQueen G, et al. Canadian association of gastroenterology clinical practice guideline for the management of ırritable bowel syndrome (IBS). J Can Assoc Gastroenterol. 2019:2(1):6-29. doi:10.1093/jcag/gwy071
  • GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018:17(11):954-976. doi:10.1016/S1474-4422(18)30322-3
  • Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice?. J Headache Pain. 2018:19(1):17. doi:10.1186/s10194-018-0846-2
  • Lau CI, Lin CC, Chen WH, Wang HC, Kao CH. Association between migraine and irritable bowel syndrome: a population-based retrospective cohort study. Eur J Neurol. 2014:21(9):1198-1204. doi:10.1111/ene.12468
  • Bartley J. Could glial activation be a factor in migraine?. Med Hypotheses. 2009:72(3):255-257. doi:10.1016/j.mehy.2008.09.048
  • Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018:38(1):1-211. doi:10.1177/0333102417738202
  • American Headache Society. The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice. 2019:59(1):1-18. doi:10.1111/head.13456
  • Starling AJ, Dodick DW. Best practices for patients with chronic migraine: burden, diagnosis, and management in primary care. Mayo Clin Proc. 2015:90(3):408-414. doi:10.1016/j.mayocp.2015.01.010
  • Dodick DW. A phase-by-phase review of migraine pathophysiology. Headache. 2018:58 Suppl 1:4-16. doi:10.1111/head.13300
  • Dodick D, Silberstein S. Central sensitization theory of migraine: clinical implications. Headache. 2006:46 Suppl 4:S182-S191. doi:10.1111/j.1526-4610.2006.00602.x
  • Mayer EA, Tillisch K, Gupta A. Gut/brain axis and the microbiota. J Clin Invest. 2015:125(3):926-938. doi:10.1172/JCI76304
  • Noseda R, Borsook D, Burstein R. Neuropeptides and neurotransmitters that modulate thalamo-cortical pathways relevant to migraine headache. Headache. 2017:57 Suppl 2(Suppl 2):97-111. doi:10.1111/head.13083
  • Filpa V, Moro E, Protasoni M, Crema F, Frigo G, Giaroni C. Role of glutamatergic neurotransmission in the enteric nervous system and brain-gut axis in health and disease. Neuropharmacology. 2016:111:14-33. doi:10.1016/j.neuropharm.2016.08.024
  • Ramachandran R. Neurogenic inflammation and its role in migraine. Semin Immunopathol. 2018:40(3):301-314. doi:10.1007/s00281-018-0676-y
  • Xie Y, Zhou G, Xu Y, et al. Effects of diet based on ıgg elimination combined with probiotics on migraine plus ırritable bowel syndrome. Pain Res Manag. 2019:2019:7890461. doi:10.1155/2019/7890461
  • Mulak A, Paradowski L. Migraine and irritable bowel syndrome. Neurol Neurochir Pol. 2005:39(4 Suppl 1):S55-S60.
  • Vandvik PO, Wilhelmsen I, Ihlebaek C, Farup PG. Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications. Aliment Pharmacol Ther. 2004:20(10):1195-1203. doi:10.1111/j.1365-2036.2004.02250.x
  • Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA. Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterol. 2006:6:26. doi:10.1186/1471-230X-6-26
  • Chang FY, Lu CL. Irritable bowel syndrome and migraine: bystanders or partners?. J Neurogastroenterol Motil. 2013:19(3):301-311. doi:10.5056/jnm.2013.19.3.301
  • Li C, Yu S, Li H, et al. Clinical features and risk factors for irritable bowel syndrome in Migraine patients. Pak J Med Sci. 2017:33(3):720-725. doi:10.12669/pjms.333.12379
  • Cady RK, Farmer K, Dexter JK, Hall J. The bowel and migraine: update on celiac disease and irritable bowel syndrome. Curr Pain Headache Rep. 2012:16(3):278-286. doi:10.1007/s11916-012-0258-y
  • Beuthin J, Veronesi M, Grosberg B, Evans RW. Gluten-free diet and migraine. Headache. 2020:60(10):2526-2529. doi:10.1111/head.13993
  • Alfaro Cruz L, Minard C, Guffey D, Chumpitazi BP, Shulman RJ. Does a minority of children with functional gastrointestinal disorders receive formal diet advice?. JPEN J Parenter Enteral Nutr. 2020:44(8):1525-1529. doi:10.1002/jpen.1771
  • Arroyave Hernández CM, Echavarría Pinto M, Hernández Montiel HL. Food allergy mediated by IgG antibodies associated with migraine in adults. Rev Alerg Mex. 2007:54(5):162-168.
  • Aydinlar EI, Dikmen PY, Tiftikci A, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013:53(3):514-525. doi:10.1111/j.1526-4610.2012.02296.x