Thompson Alex J, Bourke Claire D, Robertson Ruairi C, Shivakumar Nirupama, Edwards Christine A, Preston Tom, Holmes Elaine, Kelly Paul, Frost Gary, Morrison Douglas J
Hamlyn Centre for Robotic Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK.
Gut. 2021 Jun 8;70(8):1580-94. doi: 10.1136/gutjnl-2020-323609.
Gut function remains largely underinvestigated in undernutrition, despite its critical role in essential nutrient digestion, absorption and assimilation. In areas of high enteropathogen burden, alterations in gut barrier function and subsequent inflammatory effects are observable but remain poorly characterised. Environmental enteropathy (EE)-a condition that affects both gut morphology and function and is characterised by blunted villi, inflammation and increased permeability-is thought to play a role in impaired linear growth (stunting) and severe acute malnutrition. However, the lack of tools to quantitatively characterise gut functional capacity has hampered both our understanding of gut pathogenesis in undernutrition and evaluation of gut-targeted therapies to accelerate nutritional recovery. Here we survey the technology landscape for potential solutions to improve assessment of gut function, focussing on devices that could be deployed at point-of-care in low-income and middle-income countries (LMICs). We assess the potential for technological innovation to assess gut morphology, function, barrier integrity and immune response in undernutrition, and highlight the approaches that are currently most suitable for deployment and development. This article focuses on EE and undernutrition in LMICs, but many of these technologies may also become useful in monitoring of other gut pathologies.
尽管肠道功能在必需营养素的消化、吸收和同化过程中起着关键作用，但在营养不良的情况下，肠道功能仍在很大程度上未得到充分研究。在肠道病原体负担较高的地区，可以观察到肠道屏障功能的改变以及随之而来的炎症反应，但对其特征的了解仍然很少。环境性肠病（EE）——一种影响肠道形态和功能、以绒毛变钝、炎症和通透性增加为特征的疾病——被认为在生长发育迟缓（发育不良）和重度急性营养不良中起作用。然而，缺乏定量表征肠道功能能力的工具，既阻碍了我们对营养不良时肠道发病机制的理解，也阻碍了对旨在加速营养恢复的肠道靶向治疗的评估。在这里，我们调查了改善肠道功能评估的潜在解决方案的技术前景，重点关注可在低收入和中等收入国家（LMICs）的现场护理点部署的设备。我们评估了技术创新在评估营养不良时肠道形态、功能、屏障完整性和免疫反应方面的潜力，并强调了目前最适合部署和开发的方法。本文重点关注低收入和中等收入国家的环境性肠病和营养不良，但这些技术中的许多也可能在监测其他肠道疾病方面变得有用。
