Why is inflammatory bowel disease so prevalent in the west?

Summary

These studies suggest that alterations in the gut microbiome are strongly associated with the development, progression, and treatment of inflammatory bowel disease (IBD).

Introduction

Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract, encompassing Crohn's disease and ulcerative colitis. Recent research has increasingly focused on the role of the gut microbiome in the pathogenesis, progression, and treatment of IBD. This synthesis aims to consolidate findings from multiple studies to understand how alterations in the gut microbiome affect the prevalence and management of IBD.

Key Insights

• Gut Microbiome Dysbiosis in IBD:

  • IBD is associated with significant alterations in the gut microbiome, including reduced species richness and diversity and lower temporal stability.

  • Specific microbial taxa, such as increased facultative anaerobic bacteria (e.g., Enterobacteriaceae) and decreased beneficial bacteria, are commonly observed in IBD patients.

• Microbial Metabolites and Immune Response:

  • Microbial metabolites, such as short-chain fatty acids, bile acids, and tryptophan metabolites, play crucial roles in immune maturation, homeostasis, and mucosal integrity. Alterations in these metabolites are linked to IBD pathogenesis.

  • Certain bacteria, like Ruminococcus gnavus and adherent invasive Escherichia coli, have been identified as key players in gut inflammation and IBD.

• Environmental and Genetic Interactions:

  • Environmental factors (e.g., diet, antibiotic use, smoking) and genetic predispositions significantly influence gut microbiota composition and IBD development.

  • Mutations in genes involved in microbiome-immune interactions are frequently found in IBD patients, suggesting a genetic basis for microbiome-related immune dysregulation.

• Microbiome-Based Therapeutics:

  • Therapies targeting the gut microbiome, such as probiotics, prebiotics, antibiotics, and faecal microbiota transplantation, show promise in managing IBD by restoring microbial balance.

  • Longitudinal studies and multi-omics approaches are essential for understanding the causal relationships between microbiome alterations and IBD and developing effective microbiome-based treatments.

• Impact of Maternal IBD on Offspring:

  • Infants born to mothers with IBD exhibit altered gut microbiota, which can affect their immune system development and potentially increase their risk of developing IBD later in life.

Conclusion

The gut microbiome plays a significant role in the prevalence and management of IBD. Dysbiosis, characterised by reduced microbial diversity and specific alterations in microbial taxa, is a hallmark of IBD. Microbial metabolites and their interactions with the host immune system are crucial in the disease's pathogenesis. Environmental and genetic factors further modulate these microbial communities, influencing IBD development. Microbiome-based therapies offer promising avenues for treatment, although more research is needed to establish causality and optimise these interventions. Understanding the gut microbiome's role in IBD could lead to innovative diagnostic, prognostic, and therapeutic strategies.

Sources:

1. T. Zuo et al. "The Gut Microbiota in the Pathogenesis and Therapeutics of Inflammatory Bowel Disease." Frontiers in Microbiology, 9 (2018).

2. Mirae Lee et al. "Inflammatory Bowel Diseases (IBD) (Inflammatory Bowel Diseases and the Microbiome: Searching the Crime Scene for Clues).." Gastroenterology (2020).

3. Laila Aldars-García et al. "Systematic Review: The Gut Microbiome and Its Potential Clinical Application in Inflammatory Bowel Disease." Microorganisms, 9 (2021).

4. M. Schirmer et al. "Microbial genes and pathways in inflammatory bowel disease." Nature Reviews Microbiology, 17 (2019): 497 - 511.

5. Kerri Glassner et al. "The microbiome and inflammatory bowel disease.." The Journal of allergy and clinical immunology, 145 1 (2020): 16-27 .

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