Mécanismes périphériques et centraux de l'hypersensibilité viscérale

Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), which affect 5% people in the U.S. and northern European countries, result in chronic visceral pain of unknown etiology. Pharmacological treatments are thus often palliative or not very effective. This review summarizes the current knowledge on peripheral and central mechanisms of colonic pain in IBS and IBD. The role of the commensal microflora and the enteric nervous system in peripheral inflammation and sensitization of intestinal nociceptors is emphasized. Moreover, supraspinal modulatory influences (descending pathways, stress, hypervigilance) on spinal cord activity and gut physiology are presented. These data highlight the critical role of the brain-gut axis in the pathophysiology of IBS and IBD through neuro-immune and neuro-enteric interactions.