偏頭痛與腸躁症有關


  【24drs.com】一篇初步研究暗示,偏頭痛及緊張型頭痛可能與腸躁症(irritable bowel syndrome,IBS)有關。
  
  土耳其伊斯坦堡大學Derya Uluduz醫師表示,我們的結果認為,IBS和原發性頭痛疾患(特別是偏頭痛)之間,相當可能有表現型和基因型關聯,證據顯示可能存有共同的病理生理因素。
  
  Uluduz醫師指出,應更加注意這些狀況的共病症與它們的潛在影響,以更瞭解與處置這些疾病;醫師應檢查偏頭痛和緊張型頭痛患者有無出現IBS,反之亦然,以便對這些疾病做出正確處置。
  
  這篇研究即將在4月發表於加拿大溫哥華舉辦的美國神經科學院(AAN)第68屆年會,於2月23日先行發佈。
  
  Uluduz醫師解釋,設計這篇研究時,我們對IBS和偏頭痛是否在相同的中樞敏感症候群內共同存在、有表現型和基因型之關聯感到興趣,我們已經知道,腦部在IBS中扮演重要角色,IBS的特徵可能是中樞神經系統處理資訊時發生障礙,IBS患者的下視丘活動增加,代表在IBS、壓力和下視丘軸之間有所關聯。在這方面,IBS可以被定義為腸道的偏頭痛。
  
  這篇研究包括了107名偏頭痛患者、53名發作性緊張型頭痛(ETTH)患者、107名IBS患者與53名健康對照組。Uluduz醫師表示,這是第一篇探討IBS和ETTH等原發性頭痛關係的研究,研究方法採用全面的面對面臨床診斷評估,以及多個血清素轉運基因多樣性的資訊。
  
  研究者發現,根據嚴格標準診斷的IBS,發生於54.2%的偏頭痛患者以及28.3%的ETTH患者,另外,35.5%的IBS患者有偏頭痛、22.4%有ETTH。
  
  此外,他們針對血清素轉運基因和血清素受體2A基因的分析顯示,IBS、偏頭痛與ETTH組各有至少一個基因和健康對照組的基因不一樣。
  
  值得注意的是,Uluduz醫師表示,相較於對照組,偏頭痛和IBS患者的5-HTTLPR (LL-LS-SS)多樣性比較高,ETTH患者則否。5-HTT-VNTR基因型的10/12基因型的頻率,在偏頭痛、ETTH、IBS患者顯著比對照組更頻繁。5-HTT-VNTR基因型的12/12基因型的頻率,在偏頭痛、IBS患者顯著更頻繁,ETTH患者則否。
  
  研究者表示,需要後續研究以探討頭痛疾患和IBS之間的關聯,這將有助於治療指引。
  
  Uluduz醫師建議,抗憂鬱劑對於IBS和慢性疼痛症候群,如偏頭痛和ETTH的影響,已被證明是透過調降週邊疼痛-調節系統。隨著基因相似之處,這間接說明,這些病症在血清素系統的中樞變化上有相似之處。
  
  佛羅里達邁阿密大學米勒醫學院頭痛科主任Teshamae S. Monteith醫師受邀發表評論時表示,這關聯不完全是新的論述。
  
  Monteith醫師表示,根據臨床與流行病學觀察,人們早已認為偏頭痛和IBS有可能關聯,這個關聯是腦-腸軸與它和疾病如何相關的一個好例子。似乎存在一個基因關聯,導致干擾了活化血清素神經傳遞物質系統。Monteith醫師也認為,對於正確治療而言,評估頭痛患者的IBS是很重要的,反之亦然。
  
  通常,腹痛和頭痛患者被視為身體方面的狀況,這篇研究提供更多證據認為,原發性頭痛和IBS患者對於疼痛有生物脆弱性,根據這些結果,應繼續探討針對腦-腸軸的治療方法,這些基因、疼痛持久性和食物過敏之間的關聯也需要探討。
  
  資料來源: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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