Chowdhury Fariha, Hill Lee, Shah Nyah, Popov Jelena, Cheveldayoff Paige, Pai Nikhil
Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario.
Department of Pediatrics, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Curr Opin Gastroenterol. 2023 Nov 1;39(6):463-471. doi: 10.1097/MOG.0000000000000970. Epub 2023 Sep 18.
The intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.
We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.
The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients' outcomes. This review may also expand clinicians' understanding of what 'personalized medicine' can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients' host, and microbial physiology.
肠道微生物群在肠道上皮的发育和完整性方面发挥着重要的补充作用。这种生物学特性对于肠道适应至关重要，尤其是在导致短肠综合征（SBS）的黏膜损伤之后。本综述的目的是讨论肠道微生物群与肠道适应生理学之间的关系。
我们将探讨肠道微生物群与营养代谢之间的相互作用、导致SBS中微生物群失调的因素，以及与健康对照相比，SBS患者肠道微生物群常见的组成差异。我们还将讨论利用我们对微生物群的了解来操纵肠腔细菌并研究其产生的代谢产物，从而在这一人群中扩大诊断和治疗干预的新机会。随着微生物治疗在众多医学领域的发展，本综述及时倡导针对SBS人群的持续研究。我们的综述将讨论4个关键领域：1）SBS中肠道微生物群的生理学，2）导致失调状态的临床和治疗性损伤，3）目前关于基于微生物群的SBS管理方法的证据，以及4）激发未来研究的机会和创新。
本综述的临床意义既有当前的，也有潜在的。了解微生物群如何影响肠道适应和宿主生理学，可能会增强我们对为什么SBS患者的治疗结果存在如此大临床差异的理解。本综述还可能扩展临床医生对“个性化医学”对这一患者群体意味着什么的理解，以及我们有朝一日如何根据患者的宿主和微生物生理学来考虑我们的营养、治疗和预后建议。
