Review Article

Exploring the Ancient Persian/Unani Theory of Connection between Gastrointestinal and Respiratory Tracts: Current Evidence and Future Directions

Connection between respiratory and gastrointestinal disorders

Abstract

The theory of connection between respiratory and gastrointestinal systems is a key topic in different types of traditional medicine. In this study, we discussed the history, main concepts of this theory along with related studies and its possible clinical applications. In this regard numerous scattered studies have shown a relationship between upper and lower respiratory disorders and gastrointestinal symptoms.  Numerous epidemiologic, pathophysiologic and clinical evidence confirm the interrelationship and integrated functioning of the respiratory and gastrointestinal tracts. It seems that the holistic approach that emphasizes the link between the respiratory and gastrointestinal systems in traditional Persian medicine, is in line with the theory of united mucosa that has been considered in recent years. The interaction between the respiratory and gastrointestinal systems can occur through several mechanisms, including commonalities in embryonic sources, role of identical mediators and receptors, influence of common pathogens in the lungs and gut, similarity of microbiota patterns and changes, and same inflammatory and mucosal responses. We believe that this theory can provide new insight for the approaches to respiratory and gastrointestinal disorders in the light of holistic medical knowledge. Also, further research should be conducted to identify the exact paths and mechanisms of communication between respiratory and gastrointestinal systems.

Avicenna CoM. Dare Ehya al-Toras Institute. Beirut. Lebanon 2005.

Derakhshan AR, Khodadoost M, Ghanei M, Dehghan S. The link between allergic rhinitis and rheumatic disorders: from avicenna's view to recent findings. Indo Am J Pharm Sci 2017;4:4688-4692.

Gorji N, Moeini R, Rezaeizadeh H, Khanavi M, Farhan F. Relationship between post nasal drip (PND) and inflammatory bowel disease (IBD): a new concept on gastrointestinal disease management in persian medicine. Iran J Public Health 2014;43:1726-1727.

Pires GV, Souza HS, Elia C, Zaltman C, Carvalho ATP, et al. Small bowel of patients with asthma and allergic rhinitis: absence of inflammation despite the presence of major cellular components of allergic inflammation. Allergy Asthma Proc 2004;25:253-259.

Jones M, Walker M, Ford A, Talley N. The overlap of atopy and functional gastrointestinal disorders among 23 471 patients in primary care. Aliment Pharmacol Ther 2014;40:382-391.

Ho SW, Lin CP, Ku MS. The impact of allergic rhinitis on gastrointestinal disorders among young adults. J Eval Clin Pract 2020;26:242-247.

Savino F, Castagno E, Bretto R, Brondello C, Palumeri E, et al. A prospective 10‐year study on children who had severe infantile colic. Acta Paediatrica 2005;94:129-132.

Finocchio E, Locatelli F, Sanna F, Vesentini R, Marchetti P, et al. Gastritis and gastroesophageal reflux disease are strongly associated with non-allergic nasal disorders. BMC Pulm Med 2021;21:53.

Tobin MC, Moparty B, Farhadi A, DeMeo MT, Bansal PJ, et al. Atopic irritable bowel syndrome: a novel subgroup of irritable bowel syndrome with allergic manifestations. Ann Allergy Asthma Immunol 2008;100:49-53.

Powell N, Huntley B, Beech T, Knight W, Knight H, et al. Increased prevalence of gastrointestinal symptoms in patients with allergic disease. Postgrad Med J 2007;83:182-186.

Wang H, Liu J-S, Peng S-H, Deng X-Y, Zhu D-M, et al. Gut-lung crosstalk in pulmonary involvement with inflammatory bowel diseases. World J Gastroenterol 2013;19:6794.

Pasalar M, Nimrouzi M, Choopani R, Mosaddegh M, Kamalinejad M, et al. Functional dyspepsia: A new approach from traditional Persian medicine. Avicenna J Phytomed 2016;6:165-174.

Derakhshan AR, Yousefi M, Dehghan S, Zargaran A, Khodadoost M. Digestion process and causes of indigestion based on Avicenna's view and modern medicine. Tradit Med Res 2019;4:140.

Liu P, Wang P, Tian D, Liu J, Chen G, et al. Study on traditional Chinese medicine theory of lung being connected with large intestine. J Tradit Chin Med 2012;32:482-487.

Anushiravani M, Azad FJ, Taghipour A, Mirsadraee M, Afshari JT, et al. The effect of Plantago major seed and Almond gum on refractory asthma: A proof-of-concept study. J Herb Med 2020;19:100297.

Derakhshan AR. The link between allergic rhinitis and gastrointestinal disorders: a bridge between Persian medicine and modern findings. Adv Integr Med 2019;6:S121.

Avicenna. The book on drugs for cardiovascular diseases. Translated by Razavi Borghei H. Tehran: Nashre Ney 2009 [in Persian].

Aghili Shirazi M. Khulasah al-Hikmah. Esma'ilian Publications. Qom 2006.

MA A. Tebb-E-Akbari. Jalaluddin Publications. Institute of Natural Medicine Restoration. Qom 2009.

Cheshti MA. Exir-e Azam (Azam’s Elixir). Iran University of Medical Science, Institute for Islamic and Complementary Medicine. Tehran 2007.

Siraisi NG. Avicenna: in Renaissance Italy : the Canon and medical teaching in Italian universities after 1500. Princeton University Press. 1987; p 410.

Caffarelli C, Deriu FM, Terzi V, Perrone F, dè Angelis G, et al. Gastrointestinal symptoms in patients with asthma. Arch Dis Child 2000;82:131-135.

Locatelli F, Finocchio E, Marcon A, Bono R, Cerveri I, et al. The association between gastritis/gastroesophageal reflux and rhinitis/rhinosinusitis. Eur Respiratory Soc 2016.

Harding SM, Richter JE, Guzzo MR, Schan CA, Alexander RW, et al. Asthma and gastroesophageal reflux: acid suppressive therapy improves asthma outcome. Am J Med 1996;100:395-405.

Nordenstedt H, Nilsson M, Johansson S, Wallander M-A, Johnsen R, et al. The relation between gastroesophageal reflux and respiratory symptoms in a population-based study: the Nord-Trøndelag health survey. Chest 2006;129:1051-1056.

Mastronarde JG. Is there a relationship between GERD and asthma? Gastroenterol Hepatol 2012;8:401.

Black P. Does atopy protect against enteric infections? Allergy 2005;60:30-34.

Bisgaard H, Li N, Bonnelykke K, Chawes BLK, Skov T, et al. Reduced diversity of the intestinal microbiota during infancy is associated with increased risk of allergic disease at school age. J Allergy Clin Immunol 2011;128:646-652.

Wu MC, Jan MS, Chiou JY, Wang YH, Wei JC. Constipation might be associated with risk of allergic rhinitis: A nationwide population-based cohort study. PLoS One 2020;15:e0239723.

Douglas JE, Saunders CJ, Reed DR, Cohen NA. A role for airway taste receptor modulation in the treatment of upper respiratory infections. Expert Rev Respir Med 2016;10:157-170.

Anand S, Mande SS. Diet, microbiota and gut-lung connection. Front Microbiol 2018;9:2147.

Shreiner AB, Kao JY, Young VB. The gut microbiome in health and in disease. Curr Opin Gastroenterol 2015;31:69.

Sze MA, Tsuruta M, Yang S-WJ, Oh Y, Man SP, et al. Changes in the bacterial microbiota in gut, blood, and lungs following acute LPS instillation into mice lungs. PLoS One 2014;9:e111228.

Marsland BJ, Trompette A, Gollwitzer ES. The gut–lung axis in respiratory disease. Ann Am Thorac Soc 2015;12(Supplement 2):S150-S156.

Vinolo MA, Rodrigues HG, Nachbar RT, Curi R. Regulation of inflammation by short chain fatty acids. Nutrients 2011;3:858-876.

Morrison DJ, Preston T. Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism. Gut Microbes 2016;7:189-200.

Franco R, Martínez-Pinilla E, Lanciego JL, Navarro G. Basic pharmacological and structural evidence for class A G-protein-coupled receptor heteromerization. Front Pharmacol 2016;7:76.

Tolhurst G, Heffron H, Lam YS, Parker HE, Habib AM, et al. Short-chain fatty acids stimulate glucagon-like peptide-1 secretion via the G-protein–coupled receptor FFAR2. Diabetes 2012;61:364-371.

Lin Q, Chauvistré H, Costa IG, Gusmao EG, Mitzka S, et al. Epigenetic program and transcription factor circuitry of dendritic cell development. Nucleic acids research. 2015;43(20):9680-93.

Lee Y, Jeong SE, Hur M, Ko S, Jeon CO. Construction and evaluation of a Korean native microbial consortium for the bioremediation of diesel fuel-contaminated soil in Korea. Front Microbiol 2018;9:2594.

Ananthan G, Stalin C, Raghunathan C. A new record of ascidians in Indian waters, from the great nicobar biosphere reserve, andaman and nicobar islands. Mar Biodivers Rec 2015;8.

Kasubuchi M, Hasegawa S, Hiramatsu T, Ichimura A, Kimura I. Dietary gut microbial metabolites, short-chain fatty acids, and host metabolic regulation. Nutrients 2015;7:2839-2849.

Li M, van Esch BC, Wagenaar GT, Garssen J, Folkerts G, et al. Pro-and anti-inflammatory effects of short chain fatty acids on immune and endothelial cells. Eur J Pharmacol 2018;831:52-59.

Ichinohe T, Pang IK, Kumamoto Y, Peaper DR, Ho JH, et al. Microbiota regulates immune defense against respiratory tract influenza A virus infection. Proc Natl Acad Sci 2011;108:5354-5359.

Looft T, Allen HK. Collateral effects of antibiotics on mammalian gut microbiomes. Gut microbes 2012;3:463-467.

McAleer JP, Kolls JK. Contributions of the intestinal microbiome in lung immunity. Eur J Immunol 2018;48:39-49.

McGhee JR, Fujihashi K. Inside the mucosal immune system. PLoS Biol 2012;10:e1001397.

Trompette A, Gollwitzer ES, Yadava K, Sichelstiel AK, Sprenger N, et al. Gut microbiota metabolism of dietary fiber influences allergic airway disease and hematopoiesis. Nature Med 2014;20:159-166.

Shukla JP, Deshpande G, Shashidhara L. Ataxin 2-binding protein 1 is a context-specific positive regulator of Notch signaling during neurogenesis in Drosophila melanogaster. Development 2017;144:905-915.

Yang P-C, Liu T, Wang B-Q, Zhang T-Y, An Z-Y, et al. Rhinosinusitis derived Staphylococcal enterotoxin B possibly associates with pathogenesis of ulcerative colitis. BMC gastroenterol 2005;5:1-14.

Khawar MB, Abbasi MH, Sheikh N. IL-32: a novel pluripotent inflammatory interleukin, towards gastric inflammation, gastric cancer, and chronic rhino sinusitis. Mediators Inflamm 2016;2016:8413768.

Nagpal R, Wang S, Solberg Woods LC, Seshie O, Chung ST, et al. Comparative microbiome signatures and short-chain fatty acids in mouse, rat, non-human primate, and human feces. Front Microbiol 2018;9:2897.

Gaudino SJ, Kumar P. Cross-talk between antigen presenting cells and T cells impacts intestinal homeostasis, bacterial infections, and tumorigenesis. Front Immunol 2019;10:360.

Gutzeit C, Magri G, Cerutti A. Intestinal IgA production and its role in host‐microbe interaction. Immunol Rev 2014;260:76-85.

Vasconcelos J, Galyean M. Nutritional recommendations of feedlot consulting nutritionists: The 2007 Texas Tech University survey. J Anim Sci 2007;85:2772-2781.

Kalliomäki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. The Lancet 2003;361:1869-1871.

Bowatte G, Lodge C, Lowe AJ, Erbas B, Perret J, et al. The influence of childhood traffic‐related air pollution exposure on asthma, allergy and sensitization: a systematic review and a meta‐analysis of birth cohort studies. Allergy 2015;70:245-256.

Files
IssueVol 9, No 4, 2024 QRcode
SectionReview Article(s)
DOI https://doi.org/10.18502/tim.v9i4.17481
Keywords
Respiratory system Digestive system Gut-Lung axis Persian medicine Complementary medicine

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Saeidinejat S, Zaidi SMA, Ranjbar A, Derakhshan A. Exploring the Ancient Persian/Unani Theory of Connection between Gastrointestinal and Respiratory Tracts: Current Evidence and Future Directions. Trad Integr Med. 2024;9(4):488-495.