From clinical uncertainties to precision medicine: the emerging role of the gut barrier and microbiome in small bowel functional diseases

ABSTRACT

Introduction: Over the last decade, remarkable progress has been made in the understanding of disease pathophysiology. Many new theories expound on the importance of emerging factors such as microbiome influences, genomics/omics, stem cells, innate intestinal immunity or mucosal barrier complexities. This has introduced a further dimension of uncertainty into clinical decision-making, but equally, may shed some light on less well-understood and difficult to manage conditions.

Areas covered: Comprehensive review of the literature on gut barrier and microbiome relevant to small bowel pathology. A PubMed/Medline search from 1990 to April 2017 was undertaken and papers from this range were included.

Expert commentary: The scenario of clinical uncertainty is well-illustrated by functional gastrointestinal disorders (FGIDs). The movement towards achieving a better understanding of FGIDs is expressed in the Rome IV guidelines. Novel diagnostic and therapeutic protocols focused on the GB and SB microbiome can facilitate diagnosis, management and improve our understanding of the underlying pathological mechanisms in FGIDs.

KEYWORDS:

• Microbiota
• small bowel
• gut barrier
• irritable bowel syndrome
• functional dyspepsia
• FGIDs
• microbiome
• capsule endoscopy
• clinical uncertainty

Declaration of interest

W Marlicz has received honoraria for speaking and education support from Alfa-Wasserman, Astellas, Takeda, and Mylan and is a foundation shareholder in Sanprobi. I Loniewski is a foundation shareholder in Sanprobi. S van Hemert is an employee of Winclove probiotics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.