Department of Global Health, University of Washington, 325 9th Avenue (Box 359931), Seattle, WA, 98104, USA.
Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, F-262, Box 357236, Seattle, WA, 98195, USA.
BMC Med. 2019 Nov 25;17(1):181. doi: 10.1186/s12916-019-1417-3.
Environmental enteric dysfunction (EED) is an acquired enteropathy of the small intestine, characterized by enteric inflammation, villus blunting and decreased crypt-to-villus ratio. EED has been associated with poor outcomes, including chronic malnutrition (stunting), wasting and reduced vaccine efficacy among children living in low-resource settings. As a result, EED may be a valuable interventional target for programs aiming to reduce childhood morbidity in low and middle-income countries.
Several highly plausible mechanisms link the proposed pathophysiology underlying EED to adverse outcomes, but causal attribution of these pathways has proved challenging. We provide an overview of recent studies evaluating the causes and consequences of EED. These include studies of the role of subclinical enteric infection as a primary cause of EED, and efforts to understand how EED-associated systemic inflammation and malabsorption may result in long-term morbidity. Finally, we outline recently completed and upcoming clinical trials that test novel interventions to prevent or treat this highly prevalent condition.
Significant strides have been made in linking environmental exposure to enteric pathogens and toxins with EED, and in understanding the multifactorial mechanisms underlying this complex condition. Further insights may come from several ongoing and upcoming interventional studies trialing a variety of novel management strategies.
环境肠道功能障碍（EED）是一种获得性小肠肠病，其特征为肠道炎症、绒毛变钝和隐窝-绒毛比降低。EED 与不良结局相关，包括生活在资源匮乏环境中的儿童中的慢性营养不良（发育迟缓）、消瘦和疫苗效力降低。因此，EED 可能是旨在减少中低收入国家儿童发病率的计划的一个有价值的干预靶点。
有几个高度合理的机制将 EED 潜在的病理生理学与不良结局联系起来，但这些途径的因果关系归因一直具有挑战性。我们概述了最近评估 EED 的原因和后果的研究。这些研究包括亚临床肠道感染作为 EED 的主要原因的研究，以及努力了解 EED 相关的全身炎症和吸收不良如何导致长期发病。最后，我们概述了最近完成和即将进行的临床试验，这些试验测试了预防或治疗这种高发疾病的新干预措施。
在将环境暴露于肠道病原体和毒素与 EED 联系起来，以及理解这种复杂疾病的多因素机制方面，已经取得了重大进展。从正在进行和即将进行的几种干预性研究中，可能会有更多的见解来尝试各种新的管理策略。
