4.4 Review

Role of the duodenal microbiota in functional dyspepsia

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Summary: This study compared the duodenal and stool microbiomes of PPI users and non-users, finding differences in the relative abundance of certain microbial families in the duodenal and stool microbiomes of PPI users. However, PPI use was not associated with higher rates of SIBO. The clinical implications of these findings remain unclear.

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Summary: Functional dyspepsia (FD) is a condition characterized by recurring upper gastrointestinal symptoms without identifiable pathology. Psychological stress and dysregulation of hypothalamic-pituitary-adrenal (HPA) axis hormones have been implicated in the onset of FD. Recent research has identified a mechanistic link between corticotropin-releasing hormone (CRH) and the innate immune protein NLRP6, which regulates GI mucus secretion. This study found that FD patients exhibited dysregulation of duodenal HPA signaling, decreased NLRP6 expression, and impaired goblet cell function. These findings suggest that dysregulation of the HPA axis and NLRP6-autophagy axis may contribute to the symptoms of FD.

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Summary: It is increasingly recognized that duodenal disturbances play a role in functional dyspepsia (FD), affecting mucosal ion transport and gene expression. In this study, duodenal mucosal ion transport and associated gene expression were found to be altered in FD patients compared to healthy controls. The findings suggest that upregulated miRNAs may contribute to the downregulation of genes involved in ion transport in FD.

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Giovanni Sarnelli et al.

Summary: The study found that patients with functional dyspepsia show an enhanced response of increased mast cells and their mediators in acidic environment. By modulating TRPV receptors and mast cell activation, PEA could be considered an attractive therapeutic strategy for treating FD.

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Jan Tack et al.

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Lucas Wauters et al.

Summary: This study found that the numbers of eosinophils and immune cells in the duodenum, as well as permeability, were significantly higher in patients with functional dyspepsia, and decreased after PPI therapy. In contrast, immune cells and permeability increased in healthy volunteers on PPIs.

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Duodenal Dysbiosis and Relation to the Efficacy of Proton Pump Inhibitors in Functional Dyspepsia

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Summary: The study found differential mucus-associated genera between FD patients and controls, with Streptococcus positively correlating with duodenal eosinophils in controls. While short-term PPI therapy effects were unrelated to changes in the gut microbiota for FD patients, increased Streptococcus in controls was associated with duodenal PPI effects, even after long-term therapy withdrawal in FD stoppers.

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