Division of Gastroenterology, UCSD Center for Esophageal Diseases, University of California, San Diego School of Medicine, 9500 Gilman Drive MC 0956, La Jolla, CA, 92093, USA.
Tulane University School of Medicine, New Orleans, LA, USA.
Dig Dis Sci. 2021 Jan;66(1):12-18. doi: 10.1007/s10620-020-06720-6. Epub 2020 Nov 24.
The diverse human gut microbiome is comprised of approximately 40 trillion microorganisms representing up to 1000 different bacterial species. The human microbiome plays a critical role in gut epithelial health and disease susceptibility. While the interaction between gut microbiome and gastrointestinal pathology is increasingly understood, less is known about the interaction between the microbiome and the aerodigestive tract. This review of the microbiome of the aerodigestive tract in health, and alterations in microbiome across esophageal pathologies highlights important findings and areas for future research. First, microbiome profiles are distinct along the aerodigestive tract, spanning the oral cavity to the stomach. In patients with reflux-related disease such as gastro-esophageal reflux disease, Barrett's esophagus, and esophageal adenocarcinoma, investigators have observed an overall increase in gram negative bacteria in the esophageal microbiome compared to healthy individuals. However, whether differences in microbiome promote disease development, or if these shifts are a consequence of disease remains unknown. Interestingly, use of proton pump inhibitor therapy is also associated with shifts in the microbiome, with distinct shifts and patterns along the aerodigestive tract. The relationship between the human gut microbiome and esophageal pathology is a ripe area for investigation, and further understanding of these pathways may promote development of novel targets in prevention and therapy for esophageal diseases.
人类肠道微生物组由大约 40 万亿个微生物组成，代表了多达 1000 种不同的细菌种类。人类微生物组在肠道上皮健康和疾病易感性中起着至关重要的作用。虽然肠道微生物组与胃肠道病理学之间的相互作用越来越被理解，但对于微生物组与气消化道之间的相互作用知之甚少。本文综述了健康状态下气消化道微生物组的变化以及在食管病变中微生物组的变化，突出了重要的发现和未来的研究方向。首先，微生物组的特征沿着气消化道而不同，从口腔到胃。在与反流相关的疾病（如胃食管反流病、巴雷特食管和食管腺癌）患者中，研究人员观察到与健康个体相比，食管微生物组中革兰氏阴性菌总体增加。然而，微生物组的差异是否促进了疾病的发展，或者这些变化是否是疾病的结果仍不清楚。有趣的是，质子泵抑制剂治疗的使用也与微生物组的变化有关，在气消化道中存在明显的变化和模式。人类肠道微生物组与食管病理学之间的关系是一个值得研究的领域，进一步了解这些途径可能有助于为食管疾病的预防和治疗开发新的靶点。
