School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
AGIRA (Australian Gastrointestinal Research Alliance), Newcastle, New South Wales, Australia.
Neurogastroenterol Motil. 2022 Nov;34(11):e14372. doi: 10.1111/nmo.14372. Epub 2022 Apr 11.
Functional dyspepsia (FD) is a common and debilitating gastrointestinal disorder attributed to altered gut-brain interactions. While the etiology of FD remains unknown, emerging research suggests the mechanisms are likely multifactorial and heterogenous among patient subgroups. Small bowel motor disturbances, visceral hypersensitivity, chronic microinflammation, and increased intestinal tract permeability have all been linked to the pathogenesis of FD. Recently, alterations to the gut microbiome have also been implicated to play an important role in the disease. Changes to the duodenal microbiota may either trigger or be a consequence of immune and neuronal disturbances observed in the disease, but the mechanisms of influence of small intestinal flora on gastrointestinal function and symptomatology are unknown.
This review summarizes and synthesizes the literature on the link between the microbiota, low-grade inflammatory changes in the duodenum and FD. This review is not intended to provide a complete overview of FD or the small intestinal microbiota, but instead outline some of the key conceptual advances in understanding the interactions between altered gastrointestinal bacterial communities; dietary factors; host immune activation; and stimulation of the gut-brain axes in patients with FD versus controls. Current and emerging treatment approaches such as dietary interventions and antibiotic or probiotic use that have demonstrated symptom benefits for patients are reviewed, and their role in modulating the host-microbiota is discussed. Finally, suggested opportunities for diagnostic and therapeutic improvements for patients with this condition are presented.
功能性消化不良（FD）是一种常见的、使人虚弱的胃肠道疾病，归因于肠道-大脑相互作用的改变。尽管 FD 的病因尚不清楚，但新出现的研究表明，其机制可能是多因素的，并且在患者亚组之间存在异质性。小肠运动障碍、内脏高敏性、慢性微炎症和肠道通透性增加都与 FD 的发病机制有关。最近，肠道微生物组的改变也被认为在疾病中发挥重要作用。十二指肠微生物群的改变可能是疾病中观察到的免疫和神经元紊乱的触发因素或后果，但小肠菌群对胃肠道功能和症状的影响机制尚不清楚。
本综述总结并综合了有关微生物群、十二指肠低度炎症变化与 FD 之间联系的文献。本综述并非旨在提供 FD 或小肠微生物群的全面概述，而是概述了一些关键的概念进展，以了解改变的胃肠道细菌群落；饮食因素；宿主免疫激活；以及 FD 患者与对照组之间的肠道-大脑轴的刺激之间的相互作用。本文还回顾了目前和新兴的治疗方法，如饮食干预和抗生素或益生菌的使用，这些方法已证明对患者有症状益处，并讨论了它们在调节宿主-微生物群中的作用。最后，提出了针对这种疾病患者的诊断和治疗改进的建议机会。
