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The role of the microbiome and gut barrier in functional GI-disorders

 

 

 

 

Over the last decades we have been getting a better understanding of the  functional changes that accompany a disease. However,  the pathophysiology of many common functional gastro-intestinal disorders (FGIDs)  remains still unclear. This makes it difficult for healthcare professional to make a correct diagnosis and treatment plan. To come to a better understanding of FGDIs and their management researchers from Pomeranian Medical University in Szczecin, Poland and Winclove’have recently published a review that discusses the current knowledge on the anatomy, physiology and function of the small bowel, with a specific focus on the role of the microbiota and intestinal barrier. These insights can hopefully facilitate diagnosis and management of common gastro-intestinal disorders.

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Functional gastro-intestinal disorders such as functional dyspepsia (FD), the medical term for a condition that causes an upset stomach or pain or discomfort in the upper belly, and irritable bowel syndrome (IBS) are the most common GI-disorders in the general population. Although diagnostic tools have improved over the years, their pathophysiology is still not adequately understood, leaving treatment based on experimental or intuitive approaches. FGIDs have significant effects on patients’ quality of life and furthermore, the diagnosis comes with a certain amount of stigma, which may hinder diagnosis of other diseases. 

 

 

 

A good physician treats the disease; the great physician treats the patient who has the disease
 
 
-Sir Wiliam Osler-

 

 

 

It is presumed that alterations in the microbiome of the small bowel, low-grade mucosal inflammation and an increased intestinal permeability are involved in the development of FGIDs. The microbiome of the small bowel is poorly characterised and also varies widely between studies. The function of the microbiome in the small bowel is even less understood, but is now thought to be associated with metabolic pathways. As a significant proportion of the body’s immune cells are located in the small bowel it is likely that the human microbiota has a strong interaction with these cells. Although there is limited research into human small bowel microbiome composition, it is becoming increasingly clear that the microbiome, and its interaction with the human body via the gut barrier, plays a significant role in digestive diseases.  This  makes  novel therapeutic treatments such as probiotics a possible solution in the management of FGIDs.

In the review the authors come to the conclusion that; "Focusing on SB pathology by means of diagnostic approaches as well as novel therapeutic regimens, such as probiotics, can aid management of FGIDs and improve understanding of the underlying pathological mechanisms".

 

 

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The role of the gut barrier and microbiome in diseases of the small bowel

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