DOCSLIB.ORG

British Society of Gastroenterology Guidelines on the Gut: First Published As 10.1136/Gutjnl-2021-324598 on 26 April 2021

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
British Society of Gastroenterology Guidelines on the Gut: First Published As 10.1136/Gutjnl-2021-324598 on 26 April 2021 Guidelines British Society of Gastroenterology guidelines on the Gut: first published as 10.1136/gutjnl-2021-324598 on 26 April 2021. Downloaded from management of irritable bowel syndrome Dipesh H Vasant ,1,2 Peter A Paine,2,3 Christopher J Black ,4,5 Lesley A Houghton ,5,6 Hazel A Everitt,7 Maura Corsetti,8 Anurag Agrawal,9 Imran Aziz ,10,11 Adam D Farmer,12,13 Maria P Eugenicos,14 Rona Moss- Morris,15 Yan Yiannakou,16 Alexander C Ford 4,5 ► Additional supplemental ABSTRACT (abdominal pain or discomfort, in association material is published online Irritable bowel syndrome (IBS) remains one of the most with altered bowel habit, for at least 6 months, only. To view, please visit the journal online (http:// dx. doi. org/ common gastrointestinal disorders seen by clinicians in in the absence of alarm symptoms or signs) is 10. 1136/ gutjnl- 2021- 324598). both primary and secondary care. Since publication of the more pragmatic and may be more applicable to last British Society of Gastroenterology (BSG) guideline patients with IBS in primary care than diagnostic For numbered affiliations see end of article. in 2007, substantial advances have been made in criteria derived from patients in secondary care, understanding its complex pathophysiology, resulting in such as the Rome IV criteria (recommendation: Correspondence to its re- classification as a disorder of gut- brain interaction, weak, quality of evidence: low). Professor Alexander C Ford, rather than a functional gastrointestinal disorder. ► All patients presenting with symptoms of IBS Leeds Gastroenterology Moreover, there has been a considerable amount of for the first time in primary care should have Institute, St James’s University new evidence published concerning the diagnosis, a full blood count, C reactive protein or eryth- Hospital, Leeds, UK; alexf12399@ yahoo. com investigation and management of IBS. The primary aim rocyte sedimentation rate, coeliac serology of this guideline, commissioned by the BSG, is to review and, in patients <45 years of age with diar- DHV and PAP are joint first and summarise the current evidence to inform and guide rhoea, a faecal calprotectin to exclude inflam- authors. clinical practice, by providing a practical framework for matory bowel disease. Local and national evidence- based management of patients. One of the Received 6 March 2021 guidelines for colorectal and ovarian cancer Revised 30 March 2021 strengths of this guideline is that the recommendations screening should be followed, where indicated Accepted 6 April 2021 for treatment are based on evidence derived from a (recommendation: strong, quality of evidence: comprehensive search of the medical literature, which moderate). was used to inform an update of a series of trial- based ► Clinicians should make a positive diagnosis of and network meta- analyses assessing the efficacy of IBS based on symptoms, in the absence of alarm http://gut.bmj.com/ dietary, pharmacological and psychological therapies symptoms or signs, and abnormalities on simple in treating IBS. Specific recommendations have been blood and stool tests (recommendation: strong, made according to the Grading of Recommendations quality of evidence: moderate). Assessment, Development and Evaluation system, ► Referral to gastroenterology in secondary care summarising both the strength of the recommendations is warranted where there is diagnostic doubt, and the overall quality of evidence. Finally, this guideline in patients with symptoms that are severe, or on September 29, 2021 by guest. Protected copyright. identifies novel treatments that are in development, refractory to first- line treatments, or where the as well as highlighting areas of unmet need for future individual patient requests a specialist opinion research. (recommendation: weak, quality of evidence: low). ► There is no role for colonoscopy in IBS, other EXECUTIVE SUMMARY OF RECOMMENDATIONS than in those with alarm symptoms or signs, Doctor-patient communication or those with symptoms suggestive of IBS with ► Establishing an effective doctor- patient rela- diarrhoea who have atypical features and/or tionship and a shared understanding is key to relevant risk factors that increase the likelihood the management of IBS. Such a relationship can of them having microscopic colitis (female sex, lead to improved quality of life and symptoms, age ≥50 years, coexistent autoimmune disease, reduce healthcare visits and enhance adherence nocturnal or severe, watery, diarrhoea, dura- to treatment (recommendation: strong, quality tion of diarrhoea <12 months, weight loss or © Author(s) (or their of evidence: low). use of potential precipitating drugs including employer(s)) 2021. No ► Patients with IBS would like increased empathy, non- steroidal anti- inflammatory drugs, proton commercial re- use. See rights support and information from clinicians about pump inhibitors, etc) (recommendation: strong, and permissions. Published by BMJ. the nature of the condition, diagnosis and quality of evidence: moderate). symptom management options (recommenda- ► In those with symptoms suggestive of IBS with To cite: Vasant DH, Paine PA, tion: strong, quality of evidence: low). diarrhoea, but with atypical features such as Black CJ, et al. Gut Epub ahead of print: [please nocturnal diarrhoea, or a prior cholecystec- include Day Month Year]. Diagnosis, investigation and education tomy, 23- seleno-25- homotaurocholic acid doi:10.1136/ ► The National Institute for Health and scanning or serum 7α-hydroxy-4- cholesten- gutjnl-2021-324598 Care Excellence guideline definition of IBS 3- one should be considered to exclude bile acid Vasant DH, et al. Gut 2021;0:1–27. doi:10.1136/gutjnl-2021-324598 1 Guidelines diarrhoea (recommendation: strong, quality of evidence: ► Peppermint oil may be an effective treatment for global low). symptoms and abdominal pain in IBS. Gastro-oesophageal Gut: first published as 10.1136/gutjnl-2021-324598 on 26 April 2021. Downloaded from ► In patients with IBS and coexisting symptoms suggestive reflux is a common side effect (recommendation: weak, of a defaecatory disorder or faecal incontinence, anorectal quality of evidence: very low). physiology tests can be considered, where available, to select ► Polyethylene glycol may be an effective treatment for consti- those who might benefit from biofeedback (recommenda- pation in IBS. Abdominal pain is a common side effect tion: weak, quality of evidence: low). (recommendation: weak; quality of evidence: very low). ► There is no role for testing for exocrine pancreatic insuf- ficiency, or for hydrogen breath testing to rule out small Second-line treatments intestinal bacterial overgrowth or carbohydrate intolerance, ► Tricyclic antidepressants used as gut-brain neuromodulators in patients with typical IBS symptoms (recommendation: are an effective second- line drug for global symptoms and strong, quality of evidence: weak). abdominal pain in IBS. They can be initiated in primary or ► The diagnosis of IBS, its underlying pathophysiology and secondary care, but careful explanation as to the rationale the natural history of the condition, including common for their use is required, and patients should be counselled symptom triggers, should be explained to the patient. This about their side- effect profile. They should be commenced at should introduce the concept of IBS as a disorder of gut- a low dose (eg, 10 mg amitriptyline once a day) and titrated brain interaction, together with a simple account of the gut- slowly to a maximum of 30–50 mg once a day (recommen- brain axis and how this is impacted by diet, stress, cognitive, dation: strong, quality of evidence: moderate). behavioural and emotional responses to symptoms, and ► Selective serotonin reuptake inhibitors used as gut- brain postinfective changes (recommendation: strong, quality of neuromodulators may be an effective second-line drug for evidence: weak). global symptoms in IBS. As with tricyclic antidepressants, they can be initiated in primary or secondary care, but careful First-line treatments explanation as to the rationale for their use is required, and ► All patients with IBS should be advised to take regular exer- patients should be counselled about their side- effect profile cise (recommendation: strong, quality of evidence: weak). (recommendation: weak, quality of evidence: low). ► First- line dietary advice should be offered to all patients with ► Eluxadoline, a mixed opioid receptor drug, is an efficacious IBS (recommendation: strong, quality of evidence: weak). second- line drug for IBS with diarrhoea in secondary care. ► Food elimination diets based on IgG antibodies are not It is contraindicated in patients with prior sphincter of Oddi recommended in patients with IBS (recommendation: problems or cholecystectomy, alcohol dependence, pancrea- strong, quality of evidence: moderate). titis or severe liver impairment, and lack of availability may ► Soluble fibre, such as ispaghula, is an effective treatment limit its use (recommendation: weak, quality of evidence: for global symptoms and abdominal pain in IBS, but insol- moderate). uble fibre (eg, wheat bran) should be avoided as it may ► 5- Hydroxytryptamine 3 receptor antagonists are efficacious exacerbate symptoms. Soluble fibre should be commenced second- line drugs for IBS with diarrhoea in secondary care. http://gut.bmj.com/ at a low dose (3–4 g/day) and built up gradually to avoid Alosetron and ramosetron are unavailable in many coun- bloating (recommendation: strong; quality of evidence:
Load more

Recommended publications
  • Gut Health in Veterinary Medicine: a Bibliometric Analysis of the Literature
    animals Article Gut Health in Veterinary Medicine: A Bibliometric Analysis of the Literature Elena Colombino 1,*,† , Daniel Prieto-Botella 2,† and Maria Teresa Capucchio 1 1 Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy; [email protected] 2 Department of Surgery and Pathology, Miguel Hernandez University, 03550 Alicante, Spain; [email protected] * Correspondence: [email protected] † Equally contribution. Simple Summary: Gut health has been a main topic in veterinary medicine research after the ban on the use of antimicrobial growth promoters. Gut health has been defined as absence/prevention/avoidance of gastrointestinal disease so that the animal is able to perform its physiological functions. A biblio- metric analysis is a set of statistical methods used to explore trends in the scientific literature such as number of publications, most prolific countries and main research areas to highlight publication dynamics and gaps of knowledge. In this case, a bibliometric analysis was performed on veterinary gut health using the database Web of Science and the R package Bibliometrix. A total of 1696 docu- ments were retrieved between 2000 and 2020, showing an increase of 22.4% in the number of annual publications. Pigs (34.8%), poultry (chicken, duck, turkey and quail—33.9%) and aquaculture (fishes, crustaceans and frog—15.0%) were the most studied species while a scarce number of publications was found on felines, cows, horses, rodents, goats and sheep. China (24.7%), USA (17.2%) and Canada (5.7%) were the most productive countries. Three main research lines aimed to explore animal nutrition, prevention of inflammatory diseases and microbiota composition were identified.
    [Show full text]
  • 775 Sixth International Conference on Webometrics, Informetrics And
    Sixth International Conference on Webometrics, Informetrics and Scientometrics & Eleventh COLLNET Meeting, October 19 – 22, 2010, University of Mysore, ALGORITHMIC GENERATION OF SPECIALTY PROFILES FOR MEDICAL JOURNALS Pudovkin A.I Institute of Marine Biology, Vladivostok 690041, Russia; e-mail: [email protected] E. Garfield ThomsonReuters Scientific, 1500 Spring Garden Street, Philadelphia, PA 19130-4067, e-mail: [email protected] Abstract A procedure for generating a topical profile of a medical journal is proposed. The procedure consists in calculating of the relatedness index Rgeom of a target journal with all 50 JCR medical categories and identification of top-related ones. The set of highly related categories (3 or 5) may be regarded as the specialty profile of the target journal. We illustrate the method by considering the content of 7 medical journals, 6 specialized ones and a leading multi-scope journal: Annals of Surgery, Circulation, Clinical Infectious diseases, European Heart Journal, Gut, Shock, and New England Journal of Medicine. The data for our analyses are taken from the 2006 and 2009 JCR Science Edition ―Related Journals‖ listings for each medical category. It is shown that the resulting specialty profiles are quite stable in time and well correspond to JCR‘s assignment of journals to subject categories. JCR‘s category assignment is a heuristic procedure performed by an expert, while our procedure is comletely algorithmic. KeyWords: journal topical specification; medical journals; JCR; Journal Relatedness Indexes Introduction The problem of classification, that is, specialty characterization of journals is an old and difficult one (Katz and Hicks, 1995; Boyack et al., 2005; Klavans and Boyack, 2006; Leydesdorff, 2006; Zhang et al., 2010a, b).
    [Show full text]
  • Pancreatic Diseases and Microbiota: a Literature Review and Future Perspectives
    Journal of Clinical Medicine Review Pancreatic Diseases and Microbiota: A Literature Review and Future Perspectives Marcantonio Gesualdo , Felice Rizzi *, Silvia Bonetto, Stefano Rizza, Federico Cravero, Giorgio Maria Saracco and Claudio Giovanni De Angelis * Gastroenterology and Digestive Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; [email protected] (M.G.); [email protected] (S.B.); [email protected] (S.R.); [email protected] (F.C.); [email protected] (G.M.S.) * Correspondence: [email protected] (F.R.); [email protected] (C.G.D.A.) Received: 13 October 2020; Accepted: 30 October 2020; Published: 1 November 2020 Abstract: Gut microbiota represent an interesting worldwide research area. Several studies confirm that microbiota has a key role in human diseases, both intestinal (such as inflammatory bowel disease, celiac disease, intestinal infectious diseases, irritable bowel syndrome) and extra intestinal disorders (such as autism, multiple sclerosis, rheumatologic diseases). Nowadays, it is possible to manipulate microbiota by administering prebiotics, probiotics or synbiotics, through fecal microbiota transplantation in selected cases. In this scenario, pancreatic disorders might be influenced by gut microbiota and this relationship could be an innovative and inspiring field of research. However, data are still scarce and controversial. Microbiota manipulation could represent an important therapeutic strategy in the pancreatic diseases, in addition to standard therapies. In this review, we analyze current knowledge about correlation between gut microbiota and pancreatic diseases, by discussing on the one hand existing data and on the other hand future possible perspectives. Keywords: pancreatic diseases; microbiota; microbiome; gut microbiota; acute pancreatitis; chronic pancreatitis; diabetes mellitus; pancreatic ductal adenocarcinoma; pancreatic cystic neoplasms 1.
    [Show full text]
  • Journals from BMJ
    Journals from BMJ journals.bmj.com BMJ started out over 170 years ago as Providing high quality content for health professionals and a medical journal, publishing our first researchers across the world. Our journals include not only the BMJ, research paper. but some of the most influential speciality journals in their field. Now, as a global brand with a worldwide audience, we help medical organisations and clinicians tackle today’s most critical • In the last 12 months, over 50 million unique users accessed healthcare challenges. our subscription journals online, generating over 107 million page views. What is an Our vision is to create ‘a healthier world’. • Nearly 80% of our titles saw Impact Factor rises in 2014. Impact Factor? BMJ’s journals division now publishes more than 50 of the • 21% of our users view journal content from mobile devices. An Impact Factor (IF) is a measure of world’s leading medical and allied science journals. In doing so, the frequency with which the average we have pioneered the migration to digital publishing and the article in a journal has been cited in development of open access. a particular year. The annual Journal For more information or to of Citation Reports impact factor is a ratio between citations and recent Today, our expertise extends to medical education, clinical arrange a trial, please contact: citable items published. Thus, the decision support, data analytics and quality improvement to BMJ Consortia sales impact factor of a journal is calculated enhance day to day decision-making and healthcare delivery. by dividing the number of current E: [email protected] year citations to the source items T: +44 (0) 20 7383 6438 published in that journal during the “At BMJ we believe the work we do previous two years.
    [Show full text]
  • SCIENCE CITATION INDEX EXPANDED - JOURNAL LIST Total Journals: 8631
    SCIENCE CITATION INDEX EXPANDED - JOURNAL LIST Total journals: 8631 1. 4OR-A QUARTERLY JOURNAL OF OPERATIONS RESEARCH 2. AAPG BULLETIN 3. AAPS JOURNAL 4. AAPS PHARMSCITECH 5. AATCC REVIEW 6. ABDOMINAL IMAGING 7. ABHANDLUNGEN AUS DEM MATHEMATISCHEN SEMINAR DER UNIVERSITAT HAMBURG 8. ABSTRACT AND APPLIED ANALYSIS 9. ABSTRACTS OF PAPERS OF THE AMERICAN CHEMICAL SOCIETY 10. ACADEMIC EMERGENCY MEDICINE 11. ACADEMIC MEDICINE 12. ACADEMIC PEDIATRICS 13. ACADEMIC RADIOLOGY 14. ACCOUNTABILITY IN RESEARCH-POLICIES AND QUALITY ASSURANCE 15. ACCOUNTS OF CHEMICAL RESEARCH 16. ACCREDITATION AND QUALITY ASSURANCE 17. ACI MATERIALS JOURNAL 18. ACI STRUCTURAL JOURNAL 19. ACM COMPUTING SURVEYS 20. ACM JOURNAL ON EMERGING TECHNOLOGIES IN COMPUTING SYSTEMS 21. ACM SIGCOMM COMPUTER COMMUNICATION REVIEW 22. ACM SIGPLAN NOTICES 23. ACM TRANSACTIONS ON ALGORITHMS 24. ACM TRANSACTIONS ON APPLIED PERCEPTION 25. ACM TRANSACTIONS ON ARCHITECTURE AND CODE OPTIMIZATION 26. ACM TRANSACTIONS ON AUTONOMOUS AND ADAPTIVE SYSTEMS 27. ACM TRANSACTIONS ON COMPUTATIONAL LOGIC 28. ACM TRANSACTIONS ON COMPUTER SYSTEMS 29. ACM TRANSACTIONS ON COMPUTER-HUMAN INTERACTION 30. ACM TRANSACTIONS ON DATABASE SYSTEMS 31. ACM TRANSACTIONS ON DESIGN AUTOMATION OF ELECTRONIC SYSTEMS 32. ACM TRANSACTIONS ON EMBEDDED COMPUTING SYSTEMS 33. ACM TRANSACTIONS ON GRAPHICS 34. ACM TRANSACTIONS ON INFORMATION AND SYSTEM SECURITY 35. ACM TRANSACTIONS ON INFORMATION SYSTEMS 36. ACM TRANSACTIONS ON INTELLIGENT SYSTEMS AND TECHNOLOGY 37. ACM TRANSACTIONS ON INTERNET TECHNOLOGY 38. ACM TRANSACTIONS ON KNOWLEDGE DISCOVERY FROM DATA 39. ACM TRANSACTIONS ON MATHEMATICAL SOFTWARE 40. ACM TRANSACTIONS ON MODELING AND COMPUTER SIMULATION 41. ACM TRANSACTIONS ON MULTIMEDIA COMPUTING COMMUNICATIONS AND APPLICATIONS 42. ACM TRANSACTIONS ON PROGRAMMING LANGUAGES AND SYSTEMS 43. ACM TRANSACTIONS ON RECONFIGURABLE TECHNOLOGY AND SYSTEMS 44.
    [Show full text]
  • The Human Gut Microbiota: a Dynamic Interplay with the Host from Birth to Senescence Settled During Childhood
    Review nature publishing group The human gut microbiota: a dynamic interplay with the host from birth to senescence settled during childhood Lorenza Putignani1, Federica Del Chierico2, Andrea Petrucca2,3, Pamela Vernocchi2,4 and Bruno Dallapiccola5 The microbiota “organ” is the central bioreactor of the gastroin- producing immunological memory (2). Indeed, the intestinal testinal tract, populated by a total of 1014 bacteria and charac- epithelium at the interface between microbiota and lymphoid terized by a genomic content (microbiome), which represents tissue plays a crucial role in the mucosa immune response more than 100 times the human genome. The microbiota (2). The IS ability to coevolve with the microbiota during the plays an important role in child health by acting as a barrier perinatal life allows the host and the microbiota to coexist in a against pathogens and their invasion with a highly dynamic relationship of mutual benefit, which consists in dispensing, in modality, exerting metabolic multistep functions and stimu- a highly coordinated way, specific immune responses toward lating the development of the host immune system, through the biomass of foreign antigens, and in discriminating false well-­organized programming, which influences all of the alarms triggered by benign antigens (2). The failure to obtain growth and aging processes. The advent of “omics” technolo- or maintain this complex homeostasis has a negative impact gies (genomics, proteomics, metabolomics), characterized by on the intestinal and systemic health (2). Once the balance complex technological platforms and advanced analytical and fails, the “disturbance” causes the disease, triggering an abnor- computational procedures, has opened new avenues to the mal inflammatory response as it happens, for example, for the knowledge of the gut microbiota ecosystem, clarifying some inflammatory bowel diseases in newborns (2).
    [Show full text]
  • Editorial Board (PDF)
    Aims and Scope: Gut is a leading international journal in gastroenterology and hepatology with an established reputation for publishing first class clinical research of the alimentary tract, the liver, biliary tree and pancreas likely to impact on clinical practice within the foreseeable future. Gut delivers up-to-date, authoritative, clinically GutJournal of the British Society of Gastroenterology, oriented coverage of all areas in gastroenterology. Regular features include articles a registered charity Editor by leading authorities, commentaries on published papers, recent advances in basic Emad El-Omar (Australia) science and clinical practice, images illustrating important clinical messages Deputy Editor (Hepatology) Alexander Gerbes (Germany) (GI snapshots) and letters. The Journal has an authoritative global Editorial Board and Deputy Editor a growing international readership. (Luminal Gastroenterology) William Grady (USA) Editorial Board Deputy Editor (Endoscopy) Thomas Rösch (Germany) A Adolph (Austria) P Lochhead (USA) Contact Details A Aghemo (Italy) R Loomba (USA) Editorial Office Associate Editors R Bataller (Spain) J V Mayerle (Germany) Matias Avila (Spain) D C Baumgart (Germany) K E L McColl (UK) Gut, BMJ Journals Guy Boeckxstaens (Belgium) A Benesic (Germany) P Michl (Germany) BMA House, Tavistock Square S Ben-Horin (Israel) D J Mutimer (UK) Patrice Cani (Belgium) C Berasain (Spain) F Negro (Switzerland) London, WC1H 9JR, UK Silvio Danese (Italy) M Bernardi (Italy) N Nieto (USA) T: +44 (0)20 7383 6318 Thomas Gress (Germany)
    [Show full text]
  • Contents Commentaries Original Articles
    Contents Volume 63 Issue 5 | GUT May 2014 Commentaries 753 Characterisation of faecal protease activity 705 Oesophageal mucosal barrier: a key factor in the in irritable bowel syndrome with diarrhoea: pathophysiology of non-erosive refl ux disease OPEN ACCESS origin and effect of gut transit (NERD) and a potential target for treatment D Tooth, K Garsed, G Singh, L Marciani, C Lam, P Woodland, D Sifrim I Fordham, A Fields, R Banwait, M Lingaya, R Layfi eld, M Hastings, P Whorwell, R Spiller Gut: first published as on 1 May 2014. Downloaded from Caption: Night view of the beautiful skyline of Chicago downtown. The Gut family wish everyone 706 The antidiabetic gutsy role of metformin a very successful DDW meeting in Chicago. uncovered? Infl ammatory bowel disease R Burcelin 761 Colonic mucosa-associated diffusely adherent afaC+ Escherichia coli expressing lpfA and pks An international journal of 707 Fbxw7 hotspot mutations and human OPEN ACCESS are increased in infl ammatory bowel disease gastroenterology and hepatology colon cancer: mechanistic insights and colon cancer Impact Factor: 10.732 M Prorok-Hamon, M K Friswell, A Alswied, Editor from new mouse models C L Roberts, F Song, P K Flanagan, P Knight, Emad El-Omar (UK) J E Grim Deputy Editor (Hepatology) C Codling, J R Marchesi, C Winstanley, N Hall, Alexander Gerbes (Germany) J M Rhodes, B J Campbell Deputy Editor (Luminal 709 Editing liver tumours Gastroenterology) S Colnot, P Fortes William Grady (USA) 771 Mortality and causes of death in Crohn’s disease: results from 20 years of follow-up
    [Show full text]
  • Editorial Board and Deputy Editor a Growing International Readership
    Aims and Scope: Gut is a leading international journal in gastroenterology and hepatology with an established reputation for publishing first class clinical research of the alimentary tract, the liver, biliary tree and pancreas likely to impact on clinical practice within the foreseeable future. Gut delivers up-to-date, authoritative, clinically GutJournal of the British Society of Gastroenterology, a registered charity oriented coverage of all areas in gastroenterology. Regular features include articles Editor by leading authorities, commentaries on published papers, recent advances in basic Emad El-Omar (Australia) science and clinical practice, images illustrating important clinical messages Deputy Editor (Hepatology) Alexander Gerbes (Germany) (GI snapshots) and letters. The Journal has an authoritative global Editorial Board and Deputy Editor a growing international readership. (Luminal Gastroenterology) William Grady (USA) Deputy Editor (Endoscopy) Editorial Board Thomas Rösch (Germany) A Adolph (Austria) P Lochhead (USA) Contact Details Associate Editors A Aghemo (Italy) R Loomba (USA) Matias Avila (Spain) R Bataller (Spain) J V Mayerle (Germany) Editorial Office D C Baumgart (Germany) K E L McColl (UK) Guy Boeckxstaens (Belgium) A Benesic (Germany) P Michl (Germany) Gut Patrice Cani (Belgium) S Ben-Horin (Israel) D J Mutimer (UK) BMJ Journals, BMA House, Tavistock Square Jean-Francois Dufour (Switzerland) C Berasain (Spain) F Negro (Switzerland) London, WC1H 9JR, UK Thomas Gress (Germany) M Bernardi (Italy) N Nieto (USA) A Bertoletti
    [Show full text]
  • Leaky Gut and Gut-Liver Axis in Liver Cirrhosis: Clinical Studies Update
    Gut and Liver https://doi.org/10.5009/gnl20032 pISSN 1976-2283 eISSN 2005-1212 Review Article Leaky Gut and Gut-Liver Axis in Liver Cirrhosis: Clinical Studies Update Hiroshi Fukui Department of Gastroenterology, Nara Medical University, Kashihara, Japan Article Info Portal blood flows into the liver containing the gut microbiome and its products such as endotoxin Received January 15, 2020 and bacterial DNA. The cirrhotic liver acts and detoxifies as the initial site of microbial products. Revised June 9, 2020 In so-called “leaky gut,” the increased intestinal permeability for bacteria and their products con- Accepted June 9, 2020 stitutes an important pathogenetic factor for major complications in patients with liver cirrhosis. Published online October 21, 2020 Prolonged gastric and small intestinal transit may induce intestinal bacterial overgrowth, a condi- tion in which colonic bacteria translocate into the small gut. Cirrhotic patients further show gut Corresponding Author dysbiosis characterized by an overgrowth of potentially pathogenic bacteria and a decrease in Hiroshi Fukui autochthonous nonpathogenic bacteria. Pathological bacterial translocation (BT) is a contributing ORCID https://orcid.org/0000-0003-1832-7338 factor in the development of various severe complications. Bile acids (BAs) undergo extensive E-mail [email protected] enterohepatic circulation and play important roles in the gut-liver axis. BT-induced inflammation prevents synthesis of BAs in the liver through inhibition of BA-synthesizing enzyme CYP7A1. A lower abundance of 7α-dehydroxylating gut bacteria leads to decreased conversion of primary to secondary BAs. Decreases in total and secondary BAs may play an important role in the gut dysbiosis characterized by a proinflammatory and toxic gut microbiome inducing BT and endo- toxemia, as addressed in my previous reviews.
    [Show full text]
  • Alterations of Gut Microbiota by Overnutrition Impact Gluconeogenic Gene Expression and Insulin Signaling
    International Journal of Molecular Sciences Review Alterations of Gut Microbiota by Overnutrition Impact Gluconeogenic Gene Expression and Insulin Signaling Ling He Departments of Pediatrics and Pharmacology & Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; [email protected] Abstract: A high-fat, Western-style diet is an important predisposing factor for the onset of type 2 diabetes and obesity. It causes changes in gut microbial profile, reduction of microbial diversity, and the impairment of the intestinal barrier, leading to increased serum lipopolysaccharide (endotoxin) levels. Elevated lipopolysaccharide (LPS) induces acetyltransferase P300 both in the nucleus and cytoplasm of liver hepatocytes through the activation of the IRE1-XBP1 pathway in the endoplasmic reticulum stress. In the nucleus, induced P300 acetylates CRTC2 to increase CRTC2 abundance and drives Foxo1 gene expression, resulting in increased expression of the rate-limiting gluconeogenic gene G6pc and Pck1 and abnormal liver glucose production. Furthermore, abnormal cytoplasm- appearing P300 acetylates IRS1 and IRS2 to disrupt insulin signaling, leading to the prevention of nuclear exclusion and degradation of FOXO1 proteins to further exacerbate the expression of G6pc and Pck1 genes and liver glucose production. Inhibition of P300 acetyltransferase activity by chemical inhibitors improved insulin signaling and alleviated hyperglycemia in obese mice. Thus, P300 acetyltransferase activity appears to be a therapeutic target for the treatment of type 2 diabetes and obesity. Keywords: overnutrition; microbiota; lipopolysaccharide; acetyltransferase P300; gluconeogenic Citation: He, L. Alterations of Gut gene; insulin resistance Microbiota by Overnutrition Impact Gluconeogenic Gene Expression and Insulin Signaling. Int. J. Mol. Sci. 2021, 22, 2121. https://doi.org/ 1.
    [Show full text]
  • Gut Microbiota Composition Reflects Disease Severity and Dysfunctional
    Gut microbiota Original research Gut microbiota composition reflects disease severity Gut: first published as 10.1136/gutjnl-2020-323020 on 11 January 2021. Downloaded from and dysfunctional immune responses in patients with COVID-19 Yun Kit Yeoh ,1,2 Tao Zuo ,2,3,4 Grace Chung- Yan Lui,3,5 Fen Zhang,2,3,4 Qin Liu,2,3,4 Amy YL Li,3 Arthur CK Chung,2,3,4 Chun Pan Cheung,2,3,4 Eugene YK Tso,6 Kitty SC Fung,7 Veronica Chan,6 Lowell Ling,8 Gavin Joynt,8 David Shu- Cheong Hui,3,5 Kai Ming Chow ,3 Susanna So Shan Ng,3,5 Timothy Chun- Man Li,3,5 Rita WY Ng,1 Terry CF Yip,3,4 Grace Lai- Hung Wong ,3,4 Francis KL Chan ,2,3,4 Chun Kwok Wong,9 Paul KS Chan,1,2,10 Siew C Ng 2,3,4 ► Additional material is ABSTRACT Significance of this study published online only. To view Objective Although COVID-19 is primarily a please visit the journal online respiratory illness, there is mounting evidence (http:// dx. doi. org/ 10. 1136/ What is already known on this subject? gutjnl- 2020- 323020). suggesting that the GI tract is involved in this disease. We investigated whether the gut microbiome is linked ► SARS- CoV-2 primarily infects the respiratory For numbered affiliations see tract, however, pathophysiology of COVID-19 end of article. to disease severity in patients with COVID-19, and whether perturbations in microbiome composition, if can be attributed to aberrant immune responses in clearing the virus.
    [Show full text]