偏头痛与肠躁症有关


  【24drs.com】一篇初步研究暗示,偏头痛及紧张型头痛可能与肠躁症(irritable bowel syndrome,IBS)有关。
  
  土耳其伊斯坦堡大学Derya Uluduz医师表示,我们的结果认为,IBS和原发性头痛疾患(特别是偏头痛)之间,相当可能有表现型和基因型关联,证据显示可能存有共同的病理生理因素。
  
  Uluduz医师指出,应更加注意这些状况的共病症与它们的潜在影响,以更了解与处置这些疾病;医师应检查偏头痛和紧张型头痛患者有无出现IBS,反之亦然,以便对这些疾病做出正确处置。
  
  这篇研究即将在4月发表于加拿大温哥华举办的美国神经科学院(AAN)第68届年会,于2月23日先行发布。
  
  Uluduz医师解释,设计这篇研究时,我们对IBS和偏头痛是否在相同的中枢敏感症候群内共同存在、有表现型和基因型之关联感到兴趣,我们已经知道,脑部在IBS中扮演重要角色,IBS的特征可能是中枢神经系统处理信息时发生障碍,IBS患者的下视丘活动增加,代表在IBS、压力和下视丘轴之间有所关联。在这方面,IBS可以被定义为肠道的偏头痛。
  
  这篇研究包括了107名偏头痛患者、53名发作性紧张型头痛(ETTH)患者、107名IBS患者与53名健康对照组。Uluduz医师表示,这是第一篇探讨IBS和ETTH等原发性头痛关系的研究,研究方法采用全面的面对面临床诊断评估,以及多个血清素转运基因多样性的信息。
  
  研究者发现,根据严格标准诊断的IBS,发生于54.2%的偏头痛患者以及28.3%的ETTH患者,另外,35.5%的IBS患者有偏头痛、22.4%有ETTH。
  
  此外,他们针对血清素转运基因和血清素受体2A基因的分析显示,IBS、偏头痛与ETTH组各有至少一个基因和健康对照组的基因不一样。
  
  值得注意的是,Uluduz医师表示,相较于对照组,偏头痛和IBS患者的5-HTTLPR (LL-LS-SS)多样性比较高,ETTH患者则否。5-HTT-VNTR基因型的10/12基因型的频率,在偏头痛、ETTH、IBS患者显著比对照组更频繁。5-HTT-VNTR基因型的12/12基因型的频率,在偏头痛、IBS患者显著更频繁,ETTH患者则否。
  
  研究者表示,需要后续研究以探讨头痛疾患和IBS之间的关联,这将有助于治疗指引。
  
  Uluduz医师建议,抗忧郁剂对于IBS和慢性疼痛症候群,如偏头痛和ETTH的影响,已被证明是透过调降外围疼痛-调节系统。随著基因相似之处,这间接说明,这些病症在血清素系统的中枢变化上有相似之处。
  
  佛罗里达迈阿密大学米勒医学院头痛科主任Teshamae S. Monteith医师受邀发表评论时表示,这关联不完全是新的论述。
  
  Monteith医师表示,根据临床与流行病学观察,人们早已认为偏头痛和IBS有可能关联,这个关联是脑-肠轴与它和疾病如何相关的一个好例子。似乎存在一个基因关联,导致干扰了活化血清素神经传递物质系统。Monteith医师也认为,对于正确治疗而言,评估头痛患者的IBS是很重要的,反之亦然。
  
  通常,腹痛和头痛患者被视为身体方面的状况,这篇研究提供更多证据认为,原发性头痛和IBS患者对于疼痛有生物脆弱性,根据这些结果,应继续探讨针对脑-肠轴的治疗方法,这些基因、疼痛持久性和食物过敏之间的关联也需要探讨。
  
  资料来源:http://www.24drs.com/
  
  Native link:Migraine Linked to Irritable Bowel Syndrome

Migraine Linked to Irritable Bowel Syndrome

By Megan Brooks
Medscape Medical News

Migraine and tension-type headache may share links with irritable bowel syndrome (IBS), a preliminary study hints.

"Our results suggest a high possibility of phenotypic and genotypic associations between IBS and primary headache disorders (particularly migraine) and support the presence of some shared pathophysiology," Derya Uluduz, MD, from Istanbul University in Turkey, told Medscape Medical News.

"Greater attention should be focused on the comorbidities of these conditions and their potential contribution to better understanding and managing the disorder. Physicians should examine the presence of IBS in migraine and tension-type headache patients or vice versa for accurate management of these disorders," Dr Uluduz added.

The study was released February 23 ahead of presentation in April at the American Academy of Neurology (AAN) 68th Annual Meeting in Vancouver, Canada.

"Migraine of the Bowels"

"In designing this study, we were interested in whether IBS and migraine coexist within a same spectrum of central sensitization syndrome and have phenotypic and genotypic associations," Dr Uluduz explained. "We already knew that brain plays significant role in IBS. IBS may be characterized by dysfunctions in processing of information by the central nervous system. IBS patients have increased hypothalamic activity suggesting an association among IBS, stress and hypothalamic axis. In this respect, IBS may be defined as the 'migraine of the bowels.'"

The study included 107 people with migraine, 53 with episodic tension-type headache (ETTH), 107 with IBS, and 53 healthy individuals. "This is the first study to investigate the relationship between IBS and primary headaches, including ETTH, using a comprehensive face-to-face clinical diagnostic evaluation and information on multiple serotonin transporter gene polymorphisms," Dr Uluduz told Medscape Medical News.

The researchers found that IBS, diagnosed according to strict criteria, occurred in 54.2% of patients with migraine and 28.3% of patients with ETTH. In addition, 35.5% of patients with IBS had migraine and 22.4% had ETTH.

In addition, their analysis of the serotonin transporter gene and the serotonin receptor 2A gene showed that the IBS, migraine, and ETTH groups had at least one gene that differed from the genes of the healthy participants.

Notably, "5-HTTLPR (LL-LS-SS) polymorphisms were found to be higher in patients with migraine and IBS but not in ETTH patients compared to controls," Dr Uluduz said. "The frequency of the 10/12 genotype in the 5-HTT-VNTR genotype was significantly more frequent in patients with migraine, ETTH, and IBS compared to control subjects. The frequency of the 12/12 genotype in the 5-HTT-VNTR genotype tended to be more insignificantly frequent in patients with migraine and IBS but not in ETTH."

The researchers say further studies are needed to explore links between headache disorders and IBS, which could help guide management.

"The effects of antidepressants on IBS and chronic pain syndromes, such as migraine and ETTH, by downregulation of peripheral pain-mediating systems have been demonstrated," Dr Uluduz commented. "Along with genotypic similarities, this indirectly indicates similarities in the central alterations of the serotonergic system in these disorders."

The Brain-Gut Axis

Reached for comment, Teshamae S. Monteith, MD, chief of the Headache Division at the University of Miami's Miller School of Medicine, Florida, said the link is not entirely novel.

"Based on clinical and epidemiological observations, it has long been recognized that migraines and IBS are likely linked," Dr Monteith told Medscape Medical News. "The association is a good example of the brain-gut axis and how it relates to disease. There appears to be a genetic link resulting in disturbances within the serotoninergic neurotransmitter system."

Dr Monteith also thinks it's important to assess for the presence of IBS in headache patients and vice versa for accurate management.

"Often, patients reporting both abdominal pain and headache are labeled as somatic. The study provides further evidence to support the biological vulnerability to pain in patients with primary headache and IBS. Based on these results, the role of treatments that target the brain-gut axis should be further explored. The association between these genes, pain persistence and food sensitivities should also be explored," Dr Monteith said.

The study was supported by Mersin University. The authors have disclosed no relevant financial relationships.

To be presented at the 68th American Academy of Neurology (AAN) Annual Meeting, April 15-21, 2016. Abstract 3367.

    
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