胃肠道疾病与菌群治疗

肠道菌群通过其代谢物、分泌物或细胞成分参与调节宿主代谢和免疫,并保护宿主抵抗病原微生物入侵。环境、营养、生活习惯改变以及抗生素滥用等原因均可导致肠道微生态结构和功能失调,进而导致多种疾病。与此同时,肠道菌群亦成为极具潜力的疾病治疗手段。本文将对胃肠道疾病(包括胃肠道感染性疾病、炎症性肠病、肠易激综合征等)与菌群的关系以及基于肠道菌群治疗该类疾病的最新研究成果进行总结,并对肠道菌群在未来疾病预防和干预中的前景作出展望。     

益生菌与炎症性肠病

炎症性肠病(IBD)包括克罗恩氏病(CD)和溃疡性结肠炎(UC)，其病因和发病机制目前尚不清楚。临床研究发现，炎症性肠病患者肠道内存在菌群失调，正常细菌的数鼍减少，若给患者补充正常细菌即益生菌，使肠道内菌群失调得到纠正，可使病情缓解。1992年Fuller将益生菌定义为：经饮食摄取的能促进宿主机体微生态平衡的活微生物。本文就肠道菌群在炎症性肠病发病中的作用、益生菌对炎症性肠病的治疗作用作一简要综述。     

肠道菌群与炎症性肠病的相关性探讨

正炎症性肠病(inflammatory bowel disease,IBD)是一类发生于肠道的非特异性炎症性疾病,主要包括溃疡性结肠炎(Ulcerative colitis,UC)和克罗恩病(Crohn’s disease,CD),以腹痛、腹泻和体重下降为主要表现。普遍研究认为炎症性肠病(IBD)发病主要由环境因素、遗传易感因素、肠道屏障功能障碍、免疫功能异常及肠道菌群失调等多种因素相互作用所致。本文就肠道菌群与炎症性肠病的相关性     

肠道菌群紊乱与带状疱疹发病相关性研究进展

近年来的许多研究提示,肠道内复杂的微生物群落和人体的免疫系统间存在着极为密切的关系。免疫系统发挥正常的功能及建立免疫的稳态与肠道菌群的作用密不可分。一旦出现肠道菌群的紊乱势必会导致机体免疫功能的低下,而带状疱疹的发病与免疫低下直接相关,那么肠道菌群的紊乱与带状疱疹的发病是否有一定的关联呢,本文将对这一问题进行一个系统性综述。     

从微生物-肠-脑轴分析焦虑、抑郁与炎症性肠病关系的进展

炎症性肠病(IBD)是一种以慢性和复发为特征的特发性炎症性疾病.包括抑郁和焦虑在内的精神病共病在IBD中很常见.虽然IBD的发病机制尚未完全阐明,但肠道菌群改变(失调)被认为是IBD发病机制中的一个新因素.其次,IBD的复发和缓解过程强调了其他调节因子的重要性.因此,本研究讨论IBD和焦虑、抑郁之间的复杂关系,强调微生...     

炎症性肠病药物治疗现状与进展

炎症性肠病(IBD)是一种病因尚不明确的慢性非特异性肠道炎症性病变,包括溃疡性结肠炎(UC)和克罗恩病(CD)。其发病与遗传、环境、免疫有关。IBD在国外特别是白种人中发病率较高,随着诊断技术的提高,在国内该病的报道日渐增多。近年来对其病因、发病机理及治疗的研究取得了较大进展,尤其是一些新药的应用明显提高了疗效。对IBD的治疗,目前着眼于控制炎症和调节免疫紊乱,以有效控制疾病发作和维持缓解。传统治疗IBD的三大类药物(水杨酸类、类固醇激素类、免疫抑制剂)的研究取得了很大的发展,目前仍是治疗IBD最常用的药物。随着IBD发病…     

系统性硬化症与肠道菌群的关系

肠道菌群对人类健康和疾病有着深远影响。不仅肠道菌群能影响宿主免疫系统发育, 免疫系统本身也能改变肠道菌群。目前发现肠道菌群参与了多种自身免疫性疾病。研究发现, 系统性硬化症(systemic sclerosis, SSc)患者肠道菌群紊乱较常见, 胃肠道易受累, 且其中一些特定菌属与SSc患者胃肠道受累严重程度相关。本文对SSc患者肠道菌群变化特点、肠道菌群与SSc消化系统运动障碍和纤维化的关系以及治疗方案等方面进行系统阐述。     

P物质与炎症性肠病的研究现状

<正>炎症性肠病(inflammatory bowel disease,IBD)的发病制尚未完全明了,可能是由多种因素引起的肠道黏膜炎症和肠动力紊乱。随着"神经-免疫-内分泌网络"学说的提出及研究的深入,神经递质在IBD发病过程中的作用已逐渐得到了重视。目前已证实的肠道神经递质有血     

匹多莫德治疗小儿抗生素相关性腹泻的疗效及对免疫功能的影响

正抗生素相关性腹泻(AAD)是指在抗生素应用后因肠道菌群紊乱所引起的腹泻[1]。AAD发病原因及发病机制比较复杂,目前尚未完全阐明,但一般认为其发病是因为抗生素的应用对肠道内的正常菌群产生了抑制作用,引起肠道内菌群失调、微生态环境失衡,进而导致患儿免疫功能下降、肠道黏膜屏障损伤、肠道功能紊乱而出现腹泻[2]。作者对AAD患儿在微生态制剂等对症治疗的基础上联合应用免疫调节剂匹多莫德,取得     

肠道微生物菌群与慢性肾脏病的研究进展

正肠道微生物群与宿主一直互利共存的,并在宿主的新陈代谢中扮演着重要角色。正常肠道微生物群以营养、代谢、生理和免疫功能等多方面影响着人体健康,而肠道微生物群菌群失调参与多种疾病的发生发展,如肥胖、2型糖尿病、炎症性肠病、心血管疾病等。目前越来越多的证据表明,肠道菌群失调参与了导致慢性肾脏病(chronic kidney disease,CKD)的进展以及并发症的发生,而补充益生菌可能对CKD患者具有潜在的收益,本文就肠道微生物菌群与CKD的关系,综述如下。1肠道微生物群     

Intestinal microecology-based treatment for inflammatory bowel disease: Progress and prospects

Inflammatory bowel disease (IBD) is a chronic, recurrent, and debilitating disorder, and includes Crohn’s disease and ulcerative colitis. The pathogenesis of IBD is closely associated with intestinal dysbiosis, but has not yet been fully clarified. Genetic and environmental factors can influence IBD patients’ gut microbiota and metabolism, disrupt intestinal barriers, and trigger abnormal immune responses. Studies have reported the alteration of gut microbiota and metabolites in IBD, providing the basis for potential therapeutic options. Intestinal microbiota-based treatments such as pre/probiotics, metabolite supplementation, and fecal microbiota transplantation have been extensively studied, but their clinical efficacy remains controversial. Repairing the intestinal barrier and promoting mucosal healing have also been proposed. We here review the current clinical trials on intestinal microecology and discuss the prospect of research and practice in this field.     

Healthy gut microflora and allergy: factors influencing development of the microbiota

In humans, microbial colonization of the intestine begins just after birth. However, development of the normal flora is a gradual process, which is initially determined by factors such as compozition of the maternal gut microflora, environment and possibly also by genetic aspects. A number of variables, such as the degree of hygiene, mode of delivery, use of antibiotics or other medication and a need for nursing in incubators, can all have a substantial effect on microbial colonization and development. Current knowledge on the significance and impact of such alterations on the health of the infant is poor. However, the essential role of the gut microflora in the development of the gut immune system indicates that a close relationship between allergic sensitization and the development of the intestinal microflora may occur in infancy. Intestinal micro-organisms could down-regulate the allergic inflammation by counterbalancing type 2 T-helper cell responses and by enhancing antigen exclusion through an immunoglobulin (Ig)A response. The efficacy of probiotics (microbial food additions) in the management of food allergy has been demonstrated, and these data suggest that also prebiotics, food components that target certain indigenous gut bacteria, can possibly be used for this purpose. In conclusion, the developmental pattern of the normal gut microbiota in allergic infants poses an important research avenue, as the role of the gut microflora in the mechanisms of allergy, and thereby the possible targets for efficient bacteriotherapy, are currently undetermined.     

Healthy gut microflora and allergy: factors influencing development of the microbiota.

In humans, microbial colonization of the intestine begins just after birth. However, development of the normal flora is a gradual process, which is initially determined by factors such as composition of the maternal gut microflora, environment and possibly also by genetic aspects. A number of variables, such as the degree of hygiene, mode of delivery, use of antibiotics or other medication and a need for nursing in incubators, can all have a substantial effect on microbial colonization and development. Current knowledge on the significance and impact of such alterations on the health of the infant is poor. However, the essential role of the gut microflora in the development of the gut immune system indicates that a close relationship between allergic sensitization and the development of the intestinal microflora may occur in infancy. Intestinal micro-organisms could down-regulate the allergic inflammation by counterbalancing type 2 T-helper cell responses and by enhancing antigen exclusion through an immunoglobulin (Ig)A response. The efficacy of probiotics (microbial food additions) in the management of food allergy has been demonstrated, and these data suggest that also prebiotics, food components that target certain indigenous gut bacteria, can possibly be used for this purpose. In conclusion, the developmental pattern of the normal gut microbiota in allergic infants poses an important research avenue, as the role of the gut microflora in the mechanisms of allergy, and thereby the possible targets for efficient bacteriotherapy, are currently undetermined.     

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS.     

Probiotics for inflammatory bowel disease

Probiotics are defined as live microorganisms that may beneficially affect the host by improving the balance of the intestinal micro flora. In spontaneous animal models of inflammatory bowel disease (IBD), the influence of the enteric flora on gut inflammatory activity has been demonstrated, as germ free animals do not develop disease. Modification of the activity of the intestinal flora using probiotics has been investigated as a way of controlling IBD. However, there is still considerable work to be done before probiotics can be considered as part of the standard treatment of IBD. Probiotic cocktails should be carefully studied and the individual bacterial constituents evaluated in clinical settings. Several studies are currently underway to assess these issues. Further study of placebo controlled trial testing therapeutic role of probiotic bacteria in human trials is warranted.     

Gut microbiota and inflammatory bowel disease: The current status and perspectives

Inflammatory bowel disease (IBD) is a chronic immune-mediated disease that affects the gastrointestinal tract. It is argued that environment, microbiome, and immune-mediated factors interact in a genetically susceptible host to trigger IBD. Recently, there has been increased interest in the development, progression, and treatment of IBD because of our understanding of the microbiome. Researchers have proved that some factors can alter the microbiome and the pathogenesis of IBD. As a result, there has been increasing interest in the application of probiotics, prebiotics, antibiotics, fecal microbiota transplantation, and gene manipulation in treating IBD because of the possible curative effect of microbiome-modulating interventions. In this review, we summarize the findings from human and animal studies and discuss the effect of the gut microbiome in treating patients with IBD.     

Update on gut microbiota in gastrointestinal diseases

The human gut is a complex microbial ecosystem comprising approximately 100 trillion microbes collectively known as the “gut microbiota”. At a rough estimate, the human gut microbiome contains almost 3.3 million genes, which are about 150 times more than the total human genes present in the human genome. The vast amount of genetic information produces various enzymes and physiologically active substances. Thus, the gut microbiota contributes to the maintenance of host health; however, when healthy microbial composition is perturbed, a condition termed “dysbiosis”, the altered gut microbiota can trigger the development of various gastrointestinal diseases. The gut microbiota has consequently become an extremely important research area in gastroenterology. It is also expected that the results of research into the gut microbiota will be applied to the prevention and treatment of human gastrointestinal diseases. A randomized controlled trial conducted by a Dutch research group in 2013 showed the positive effect of fecal microbiota transplantation (FMT) on recurrent Clostridioides difficile infection (CDI). These findings have led to the development of treatments targeting the gut microbiota, such as probiotics and FMT for inflammatory bowel diseases (IBD) and other diseases. This review focuses on the association of the gut microbiota with human gastrointestinal diseases, including CDI, IBD, and irritable bowel syndrome. We also summarize the therapeutic options for targeting the altered gut microbiota, such as probiotics and FMT.     

Obesity,Diabetes, and Gut Microbiota: The hygiene hypothesis expanded?

The connection between gut microbiota and energy homeostasis and inflammation and its role in the pathogenesis of obesity-related disorders are increasingly recognized. Animals models of obesity connect an altered microbiota composition to the development of obesity, insulin resistance, and diabetes in the host through several mechanisms: increased energy harvest from the diet, altered fatty acid metabolism and composition in adipose tissue and liver, modulation of gut peptide YY and glucagon-like peptide (GLP)-1 secretion, activation of the lipopolysaccharide toll-like receptor-4 axis, and modulation of intestinal barrier integrity by GLP-2. Instrumental for gut microbiota manipulation is the understanding of mechanisms regulating gut microbiota composition. Several factors shape the gut microflora during infancy: mode of delivery, type of infant feeding, hospitalization, and prematurity. Furthermore, the key importance of antibiotic use and dietary nutrient composition are increasingly recognized. The role of the Western diet in promoting an obesogenic gut microbiota is being confirmation in subjects. Following encouraging results in animals, several short-term randomized controlled trials showed the benefit of prebiotics and probiotics on insulin sensitivity, inflammatory markers, postprandial incretins, and glucose tolerance. Future research is needed to unravel the hormonal, immunomodulatory, and metabolic mechanisms underlying microbe-microbe and microbiota-host interactions and the specific genes that determine the health benefit derived from probiotics. While awaiting further randomized trials assessing long-term safety and benefits on clinical end points, a healthy lifestyle—including breast lactation, appropriate antibiotic use, and the avoidance of excessive dietary fat intake—may ensure a friendly gut microbiota and positively affect prevention and treatment of metabolic disorders.Along with the increasing worldwide incidence of obesity-associated disorders, research has recently unraveled important pathways reciprocally connecting metabolism with the immune system. The development of obesity is a complex process involving genetic susceptibility and environmental factors, which both remain only partially understood. In such instances, gut microbiota is being increasingly recognized as an important factor connecting genes, environment, and immune system. The human gut hosts an enormous number and variety of microorganisms, including at least 10¹⁴ bacteria belonging to ∼1,000 species (1). The genome size of this microbial organ, collectively named microbiome, exceeds the size of the human nuclear genome by two orders of magnitude and provides important biological and metabolic functions that cannot be performed by researchers. Genomic and environmental factors at the basis of mutual host-microbiota interactions have been intensely investigated with metagenomic and metabolomic approaches in the last 5 years. This article will discuss recent advances in understanding the role of gut microbiota in the pathogenesis of obesity, insulin resistance (IR), and diabetes and their potential therapeutic applications.     

Probiotics: overview of microbiological and immunological characteristics

Over the last few years, probiotics (commercialized as food, dietary supplements of living bacteria or pharmaceuticals) have attracted the interest of scientists as well as consumers. Recent public interest in healthier lifestyles, together with the acceptance by physicians of nonmainstream therapies, has refocused attention on the role of human microbiota in the prevention and therapy of diseases. Modulation of the intestinal microbiota may be achieved by consuming living bacteria or by consuming a combination of probiotics and prebiotics. In addition, we are learning more about the biology of probiotic microorganisms, through sequencing their genomes, and the interactions of probiotics with human cells and with pathogenic bacteria. Results from well-conducted clinical studies help to increase the acceptance of probiotics for the treatment and prevention of selected diseases, both inside and outside the GI tract. Moreover, the use of selected probiotics for particular subject groups may provide more specific health effects. The medical profession is in an ideal position to guide the consumer towards appropriate prophylactic or therapeutic uses of probiotics in health or in specific disease states.     

Probiotics, prebiotics and child health: where are we going?

Changes in gastrointestinal (GI) bacteria caused by diet, antibiotics or other factors could alter enteric and systemic immune functions; changing the gut microflora composition by diet supplementation with specific live microbiota (probiotics) may be beneficial. The 'natural' target of ingested probiotics is the intestine, its microflora and associated immune system. Most published data concern use of probiotics to prevent and treat GI infections. Evidence for possible beneficial effects on mucosal barrier dysfunctions, including food allergy, inflammatory bowel disease, and respiratory and urinary tract infections, is emerging. The role of prebiotics (non-digestible oligosaccharides that reduce the growth or virulence of pathogens and induce systemic effects) is being investigated. Preliminary studies indicate that prebiotics may be useful dietary adjuncts for managing GI infections. Prebiotic and probiotic use in infants is attempting to modify a complex microbial ecosystem. Better understanding of the long-term effects of these interventions on infant gut microflora is an important goal.