The gut microbiota and the liver. Pathophysiological and clinical implications

peer-reviewedThe term microbiota is used to describe the complete population of microorganisms that populate a certain location, such as the gut, and is preferred to the term flora as the former incorporates not just bacteria but also archaea, viruses, and other microorganisms, such as protozoa. Though the potential role of the microbiota (through such concepts as ‘‘the putrefactive principle associated with faeces’’ and ‘‘intestinal toxins’’) in the pathogenesis of systemic disorders has been recognized since antiquity, a firm scientific basis for a role for the gut microbiome in liver disease did not emerge until the middle of the last century with the recognition of the relationship between hepatic coma and the absorption of nitrogenous substances from the intestine [1]. This was followed by the description of abundant coliforms in the small intestine of cirrhotics [2] and the role of bacteria was clinched by trials demonstrating that antibiotics led to clinical improvement in hepatic encephalopathy (HE) [3]. Subsequently, these same gut-derived bacteria were implicated in another complication of chronic liver disease and portal hypertension, spontaneous bacterial peritonitis. Most recently, more credence has been given to a suggestion that has lingered in the background for decades, namely, that the gut microbiota might play a role in the pathogenesis or progression of certain liver diseases, including alcoholic liver disease [4], non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steato-hepatitis (NASH) [5], total parenteral nutrition (TPN)/intestinal failure-related liver disease (IFALD) [6], and primary sclerosing cholangitis (PSC) [7], either through the direct effects of bacteria or their products, via inflammatory mediators such as tumor necrosis factor a (TNF), whose release had been triggered by constituents of the microbiota, or, as in the case of primary sclerosing cholangitis (PSC), through cross-reactivity between microbial antigens and human tissue components (e.g., atypical anti-nuclear cytoplasmic antibodies (p-ANCA), in PSC, recognize both tubulin beta isoform 5 in human neutrophils, and the bacterial cell division protein FtsZ) [8]. Indeed, inflammatory mediators have also been implicated in the development and maintenance of the hyperdynamic circulation that is a feature of portal hypertension [9], in impairing liver function and contributing to haemostatic failure [10]. It is in these contexts that modulation of the microbiota has emerged as a potential therapeutic strategy in the management of liver diseas

Report from the multinational irritable bowel syndrome initiative 2012

Q1Q1In 2012, a group of 29 internationally recognized experts in the pathophysiology, diagnosis, and treatment of irritable bowel syndrome (IBS) convened to audit the current state of IBS research. The meeting was preceded by a comprehensive online survey that focused on research needs for IBS diagnosis (particularly the strengths and shortcomings of current criteria), definitions used in clinical trials for IBS patients and “healthy controls,” potential biomarkers for IBS, and outcome measures in drug trials. While the purpose of the meeting was not to make binding recommendations, participants developed a framework for future questions and research needs in IBS. First, participants indicated the need for revised criteria for the diagnosis of IBS; in particular, inclusion of bloating and de-emphasis of pain as criteria were considered critical needs. Second, participants noted that definitions of normal, healthy controls varied widely among clinical trials; these definitions need to be standardized not only to improve the reliability of results, but also to better facilitate inter-trial comparisons and data synthesis. Third, participants highlighted the need for accurate biomarkers of disease. Fourth and finally, participants noted that further defining outcome measures, so that they are functionally relevant and reflect normalization of bowel function, is a critical need. Together, the discussions held at this workshop form a framework to address future research in IBS.https://orcid.org/0000-0002-9219-4548Revista Internacional - Indexad

Management of Platelet-Directed Pharmacotherapy in Patients With Atherosclerotic Coronary Artery Disease Undergoing Elective Endoscopic Gastrointestinal Procedures

The periprocedural management of patients with atherosclerotic coronary heart disease, including those who have heart disease and those who are undergoing percutaneous coronary intervention and stent placement who might require temporary interruption of platelet-directed pharmacotherapy for the purpose of an elective endoscopic gastrointestinal procedure, is a common clinical scenario in daily practice. Herein, we summarize the available information that can be employed for making management decisions and provide general guidance for risk assessment

The Gut-Brain Axis and the Microbiome: Clues to Pathophysiology and Opportunities for Novel Management Strategies in Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is one of the most common of all medical disorders worldwide and, while for some it represents no more than a nuisance, for others it imposes significant negative impacts on daily life and activities. IBS is a heterogeneous disorder and may well have a number of causes which may lie anywhere from the external environment to the contents of the gut lumen and from the enteric neuromuscular apparatus and the gut immune system to the central nervous system. Consequently, the paradigm of the gut-brain axis, which includes the participation of these various factors, has proven a useful model to assist clinicians and patients alike in understanding the genesis of symptoms in IBS. Now, given the widespread interest in the gut microbiome in health and disease, in general, reports of disordered enteric bacterial communities in IBS, and experimental data to indicate that components of the gut microbiota can influence brain morphology and function, as well as behavior and cognition, this concept has been extended to encompass the microbiota-gut-brain axis. The implications of this novel concept to the assessment and management of IBS will be explored in this review

Review: Do patients with functional gastrointestinal disorders have an altered gut flora?

The description of the de novo development of irritable bowel syndrome (IBS) following an episode of bacterial gastroenteritis (postinfectious IBS) illustrated the potential for a luminal factor (a bacterial pathogen) to cause this common gastrointestinal ailment. As a consequence of these and other observations as well as results of experiments involving animal models, the enteric flora and the immune response that it generates in the host have, somewhat surprisingly, come centre-stage in IBS research with their potential to induce the pathophysiological changes that are associated with IBS. While evidence for immune dysfunction both in the mucosa and systemically continues to accumulate, methodological limitations have hampered a full delineation of the nature of the microbiota in IBS. The latter is eagerly awaited and may yet provide a firm rationale for the use of certain probiotics and antibiotics in IBS, whose benefits have now been described with some consistency