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Z Gastroenterol 2023; 61(08): 1037-1045
DOI: 10.1055/a-2013-7633
Übersicht

Das Bauchgehirn: neuroanatomische Perspektiven für den Viszeralchirurgen

The abdominal brain: neuroanatomic perspectives for the abdominal surgeon
Erik Wolniczak   *
1   Institut für Anatomie, Otto-von-Guericke-Universität zu Magdeburg, Magdeburg, Deutschland
,
Frank Meyer
2   Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
,
Anne Albrecht
1   Institut für Anatomie, Otto-von-Guericke-Universität zu Magdeburg, Magdeburg, Deutschland
3   Center for Behavioral Brain Science (CBBS), Magdeburg, Germany
4   Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
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Zusammenfassung

Unser „Bauchgehirn“ besteht nicht nur aus einem eigenständig tätigen enterischen Nervensystem, sondern auch aus bidirektionalen Verbindungen mit Parasympathikus und Sympathikus sowie zu Gehirn und Rückenmark. Neue Studien zeigen, dass diese Verbindungen schnell Informationen über die aufgenommene Nahrung an das Gehirn weiterleiten können, um so das Hungergefühl und komplexes Verhalten wie Belohnungslernen zu steuern. Aber auch unser emotionales Erleben, insbesondere Stress, hat einen starken Einfluss auf das gastrointestinale System. Das Immunsystem, die Motilität und die Barrierefunktion des Gastrointestinaltrakts werden außerdem stark vom intestinalen Mikrobiom moduliert. Lokale Bakterien können über freigesetzte Stoffwechselprodukte und Neuropeptide direkt die neuronale Kommunikation beeinflussen und Entzündungsfaktoren kontrollieren. Intensive Forschung in den letzten 10 Jahren konnte außerdem belegen, dass das intestinale Mikrobiom emotionale und kognitive Aspekte unseres Verhaltens beeinflusst und somit im Fokus zahlreicher neuropsychiatrischer Erkrankungen wie z. B. Depressionen und Angststörungen steht.

Dieser Übersichtsartikel soll einen kurzen Überblick über die anatomischen Grundlagen der sogenannten Darm-Gehirn-Achse geben und Modi der bidirektionalen Regulierung vorstellen. Über indirekte Verbindungen zum limbischen System kann die Darm-Gehirn-Achse wesentlich Stress und Angst, aber auch die Schmerzverarbeitung beeinflussen. Außerdem wird die Rolle des Mikrobioms erläutert und werden zukünftige Wege dargestellt, wie die (Mikrobiom-)Darm-Gehirn-Achse emotionales Erleben, Schmerzverarbeitung und Darmfunktion beeinflussen kann. Diese Zusammenhänge sind für die Weiterentwicklung der Viszeralmedizin und damit auch für den Viszeralchirurgen relevant, um interdisziplinär orientierte zukünftige Behandlungskonzepte zu entwickeln.

Abstract

The “abdominal brain“ does not only consist of a separate enteric nervous system but also of bidirectional connections to the autonomous nerve system with parasympathicus und sympathicus as well as brain and spinal cord. Novel studies have shown that these connections can quickly transfer information on the ingested nutrients to the brain to conduct the feeling of hunger and more complex behaviour, such as “reward-related learning“. However, even emotional experience, in particular, stress, has a strong impact onto the gastrointestinal system. The immune system, motility and barrier function of the gastrointestinal tract are modulated by the intestinal microbiota. Local bacteria may directly influence neuronal communication by released metabolic products and neuropeptides as well as may control inflammatory factors. Intensive research over the last 10 years was able to provide evidence that intestinal microbiota may affect emotional and cognitive aspects of our behaviour and, thus, it might be in the focus of numerous neuropsychiatric diseases, such as depressions and anxiety disorders.

The presented review is to provide a short summary of the i) anatomic basics of the so-called gut-brain axis and ii) modi of the bidirectional regulation. Through indirect connections to the limbic system, gut-brain axis can substantially influence stress and anxiety but also the pain processing. In addition, the role of microbiota is outlined and future paths are shown, e.g., how the (microbiota-)gut-brain axis may alter emotional experience, pain processing and intestinal function. Such associations are relevant for further development of visceral medicine, and, thus, also for the abdominal surgeon to derive future treatment concepts with interdisciplinary orientation.

Schlüsselwörter

enterales Nervensystem - Bauch-Hirn-Achse - N. vagus - Hirnstamm - Neuropods - intestinales Mikrobiom - Schmerz

Keywords

enteric nervous system - gut-brain axis - vagal nerve - brainstem - neuropods - intestinal microbiota - pain

* gegenwärtige Adresse siehe 2




Publication History

Received: 20 April 2022

Accepted after revision: 16 January 2023

Article published online:
04 May 2023

© 2023. Thieme. All rights reserved.

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  • Literatur

  • 1 Kaelberer MM, Buchanan KL, Klein ME. et al. A gut-brain neural circuit for nutrient sensory transduction. Science 2018; 361: eaat5236
    CrossrefPubMedSearch in Google Scholar
  • 2 Kaelberer MM, Rupprecht LE, Liu WW. et al. Neuropod Cells: The Emerging Biology of Gut-Brain Sensory Transduction. Annu Rev Neurosci 2020; 43: 337-353
    CrossrefPubMedSearch in Google Scholar
  • 3 Margolis KG, Cryan JF, Mayer EA. The Microbiota-Gut-Brain Axis: From Motility to Mood. Gastroenterology 2021; 160 (05) 1486-1501
    CrossrefPubMedSearch in Google Scholar
  • 4 Furness JB. The enteric nervous system and neurogastroenterology. Nat Rev Gastroenterol Hepatol 2012; 9 (05) 286-294
    CrossrefPubMedSearch in Google Scholar
  • 5 Spencer NJ, Hu H. Enteric nervous system: sensory transduction, neural circuits and gastrointestinal motility. Nat Rev Gastroenterol Hepatol 2020; 17 (06) 338-351
    CrossrefPubMedSearch in Google Scholar
  • 6 Costa M, Brookes SJ, Hennig GW. Anatomy and physiology of the enteric nervous system. Gut 2000; 47 (Suppl. 04) iv15-19
    CrossrefPubMedSearch in Google Scholar
  • 7 Fung C, Vanden Berghe P. Functional circuits and signal processing in the enteric nervous system. Cell Mol Life Sci 2020; 77 (22) 4505-4522
    CrossrefPubMedSearch in Google Scholar
  • 8 Benarroch EE. Physiology and Pathophysiology of the Autonomic Nervous System. Continuum (Minneap Minn) 2020; 26 (01) 12-24
    CrossrefPubMedSearch in Google Scholar
  • 9 Furness JB, Callaghan BP, Rivera LR. et al. The enteric nervous system and gastrointestinal innervation: integrated local and central control. Adv Exp Med Biol 2014; 817: 39-71
    CrossrefPubMedSearch in Google Scholar
  • 10 Duan H, Cai X, Luan Y. et al. Regulation of the Autonomic Nervous System on Intestine. Front Physiol 2021; 12: 700129
    CrossrefPubMedSearch in Google Scholar
  • 11 de Weerth C. Do bacteria shape our development? Crosstalk between intestinal microbiota and HPA axis. Neurosci Biobehav Rev 2017; 83: 458-471
    CrossrefPubMedSearch in Google Scholar
  • 12 Makris AP, Karianaki M, Tsamis KI. et al. The role of the gut-brain axis in depression: endocrine, neural, and immune pathways. Hormones (Athens) 2021; 20 (01) 1-12
    CrossrefPubMedSearch in Google Scholar
  • 13 Cryan JF, Dinan TG. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci 2012; 13 (10) 701-712
    CrossrefPubMedSearch in Google Scholar
  • 14 Guo R, Chen LH, Xing C. et al. Pain regulation by gut microbiota: molecular mechanisms and therapeutic potential. Br J Anaesth 2019; 123 (05) 637-654
    CrossrefPubMedSearch in Google Scholar
  • 15 Bohórquez DV, Shahid RA, Erdmann A. et al. Neuroepithelial circuit formed by innervation of sensory enteroendocrine cells. J Clin Invest 2015; 125 (02) 782-786
    CrossrefPubMedSearch in Google Scholar
  • 16 Beutler LR, Chen Y, Ahn JS. et al. Dynamics of Gut-Brain Communication Underlying Hunger. Neuron 2017; 96 (02) 461-475.e5
    CrossrefPubMedSearch in Google Scholar
  • 17 Han W, Tellez LA, Perkins MH. et al. A Neural Circuit for Gut-Induced Reward. Cell 2018; 175 (03) 665-678.e23
    CrossrefPubMedSearch in Google Scholar
  • 18 Ruffoli R, Giorgi FS, Pizzanelli C. et al. The chemical neuroanatomy of vagus nerve stimulation. J Chem Neuroanat 2011; 42 (04) 288-296
    CrossrefPubMedSearch in Google Scholar
  • 19 Travagli RA, Anselmi L. Vagal neurocircuitry and its influence on gastric motility. Nat Rev Gastroenterol Hepatol 2016; 13 (07) 389-401
    CrossrefPubMedSearch in Google Scholar
  • 20 Herman JP. Regulation of Hypothalamo-Pituitary-Adrenocortical Responses to Stressors by the Nucleus of the Solitary Tract/Dorsal Vagal Complex. Cell Mol Neurobiol 2018; 38 (01) 25-35
    CrossrefPubMedSearch in Google Scholar
  • 21 Castle M, Comoli E, Loewy AD. Autonomic brainstem nuclei are linked to the hippocampus. Neuroscience 2005; 134 (02) 657-669
    CrossrefPubMedSearch in Google Scholar
  • 22 Sindermann L, Redlich R, Opel N. et al. Systematic transdiagnostic review of magnetic-resonance imaging results: Depression, anxiety disorders and their co-occurrence. J Psychiatr Res 2021; 142: 226-239
    CrossrefPubMedSearch in Google Scholar
  • 23 Fanselow MS, Dong HW. Are the dorsal and ventral hippocampus functionally distinct structures?. Neuron 2010; 65 (01) 7-19
    CrossrefPubMedSearch in Google Scholar
  • 24 Duque A, Arellano JI, Rakic P. An assessment of the existence of adult neurogenesis in humans and value of its rodent models for neuropsychiatric diseases. Mol Psychiatry 2022; 27 (01) 377-382
    CrossrefPubMedSearch in Google Scholar
  • 25 Parul G, Mishra A, Singh S. . et al. Chronic unpredictable stress negatively regulates hippocampal neurogenesis and promote anxious depression-like behavior via upregulating apoptosis and inflammatory signals in adult rats. Brain Res Bull 2021; 172: 164-179
    CrossrefPubMedSearch in Google Scholar
  • 26 Du Preez A, Onorato D, Eiben I. et al. Chronic stress followed by social isolation promotes depressive-like behaviour, alters microglial and astrocyte biology and reduces hippocampal neurogenesis in male mice. Brain Behav Immun 2021; 91: 24-47
    CrossrefPubMedSearch in Google Scholar
  • 27 Matisz CE, Gruber AJ. Neuroinflammatory remodeling of the anterior cingulate cortex as a key driver of mood disorders in gastrointestinal disease and disorders. Neurosci Biobehav Rev 2022; 133: 104497
    CrossrefPubMedSearch in Google Scholar
  • 28 Sudo N, Chida Y, Aiba Y. et al. Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. J Physiol 2004; 558 (Suppl. 01) 263-275
    CrossrefPubMedSearch in Google Scholar
  • 29 Microbial Endocrinology: The Microbiota-Gut-Brain Axis in Health and Disease. Advs Exp. Medicine, Biology. Lyte M, Cryan JF. New York: Springer; 2014.
    CrossrefSearch in Google Scholar
  • 30 Saxena S, Kruys V, Vamecq J. et al. The Role of Microglia in Perioperative Neuroinflammation and Neurocognitive Disorders. Front Aging Neurosci 2021; 13: 671499
    CrossrefPubMedSearch in Google Scholar
  • 31 Peri R, Aguilar RC, Tüffers K. et al. The impact of technical and clinical factors on fecal microbiota transfer outcomes for the treatment of recurrent Clostridioides difficile infections in Germany. United European Gastroenterol J 2019; 7 (05) 716-722
    CrossrefPubMedSearch in Google Scholar
  • 32 Liptak R, Gromova B, Gardlik R. Fecal Microbiota Transplantation as a Tool for Therapeutic Modulation of Non-gastrointestinal Disorders. Front Med (Lausanne) 2021; 8: 665520
    CrossrefPubMedSearch in Google Scholar
  • 33 Brenner D, Shorten GD, O’Mahony SM. Postoperative pain and the gut microbiome. Neurobiol Pain 2021; 10: 100070
    CrossrefPubMedSearch in Google Scholar
  • 34 Noonan S, Zaveri M, Macaninch E. et al. Food & mood: a review of supplementary prebiotic and probiotic interventions in the treatment of anxiety and depression in adults. BMJ Nutr Prev Health 2020; 3 (02) 351-362
    CrossrefPubMedSearch in Google Scholar
  • 35 Fang J, Rong P, Hong Y. et al. Transcutaneous Vagus Nerve Stimulation Modulates Default Mode Network in Major Depressive Disorder. Biol Psychiatry 2016; 79 (04) 266-273
    CrossrefPubMedSearch in Google Scholar
  • 36 Usichenko TI, Hua K, Cummings M. et al. Auricular stimulation for preoperative anxiety – A systematic review and meta-analysis of randomized controlled clinical trials. J Clin Anesth 2022; 76: 110581
    CrossrefPubMedSearch in Google Scholar
  • 37 Mikami Y, Tsunoda J, Kiyohara H. et al. Vagus nerve-mediated intestinal immune regulation: therapeutic implications of inflammatory bowel diseases. Int Immunol 2022; 34 (02) 97-106
    CrossrefPubMedSearch in Google Scholar
  • 38 Bonaz B, Sinniger V, Pellissier S. Vagus Nerve Stimulation at the Interface of Brain-Gut Interactions. Cold Spring Harb Perspect Med 2019; 9 (08) a034199
    CrossrefPubMedSearch in Google Scholar