The brain-gut axis in gastrointestinal cancers

Orna Alpert; Leonid Begun; Tony Issac; Ramon Solhkhah

doi:10.21037/jgo-2019-gi-04

The brain-gut axis in gastrointestinal cancers

J Gastrointest Oncol. 2021 Jul;12(Suppl 2):S301-S310. doi: 10.21037/jgo-2019-gi-04.

Authors

Orna Alpert^{1

2}, Leonid Begun¹, Tony Issac^{1

2}, Ramon Solhkhah^{1

2}

Affiliations

¹ Department of Psychiatry, Jersey Shore University Medical Center, Neptune, NJ, USA.
² Department of Psychiatry & Behavioral Health, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA.

Abstract

Recent developments have given more credence into the brain-gut-microbiota axis and its role in the development of tumor genesis. The microbiota have multiple functions including maintenance of the epithelial barrier, immune response, digestion, cortisol regulation, and control of neurotransmitters and their metabolism [e.g., serotonin, dopamine, noradrenaline and gamma-Aminobutyric Acid (GABA)]. Changes in gut microbiota can interfere with homeostasis leading to dysbiosis microbiota, which is linked to colorectal cancer. Microbiota composition can cause pronounced effect on medical interventions including medications, chemotherapy, and radiation. Altered primary immune system is associated with microbiota disassociation and development of colorectal cancer. This article reviews the current research in brain-gut axis with focus on microbiota and its role in the development of gastrointestinal cancers. We conducted a literature review on PubMed, Cochrane, and Science direct using English language. We begin by reviewing the brain-gut axis and its function and then discuss its effect on the development of gastrointestinal cancers. We reviewed 70 manuscripts and found association between microbiota dysfunction and development of colorectal cancers predisposing to psychiatric manifestations. Lasting disturbances in the microbiota can lead to systemic inflammation with implications on disease development or treatment modifications. These disruptions of the intestinal flora can play an important role in the pathogenesis of cancers. Most psychological reactions to cancer are similar across cancer types but each cancer when examined individually has its own unique features associated with it. Correlation between fear of recurrence and the level of pathological distress is viewed as an indicator of overall adjustment to cancer survival.

Keywords: Depression; Gastrointestinal cancer; PTSD; anxiety; brain–gut axis; chemotherapy; colorectal cancer; microbes; microbiota; systemic inflammation; tumorgenesis.

Publication types

Review