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World J Gastrointest Pathophysiol. Nov 15, 2014; 5(4): 550-559
Published online Nov 15, 2014. doi: 10.4291/wjgp.v5.i4.550
Intestinal microbiota: The explosive mixture at the origin of inflammatory bowel disease?
Roberto Bringiotti, Enzo Ierardi, Rosa Lovero, Giuseppe Losurdo, Alfredo Di Leo, Mariabeatrice Principi
Roberto Bringiotti, Enzo Ierardi, Rosa Lovero, Giuseppe Losurdo, Alfredo Di Leo, Mariabeatrice Principi, Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
Author contributions: Ierardi E, Di Leo A and Principi M designed the study, revised the manuscript and approved the final version; Bringiotti R, Lovero R and Losurdo G collected the data and revised the final version before approval.
Correspondence to: Enzo Ierardi, Professor, Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy. ierardi.enzo@gmail.com
Telephone: +39-08-05592577 Fax: +39-08-05593088
Received: January 14, 2014
Revised: May 2, 2014
Accepted: July 27, 2014
Published online: November 15, 2014
Processing time: 308 Days and 14.8 Hours
Abstract

Inflammatory bowel diseases (IBDs), namely Crohn’s disease and ulcerative colitis, are lifelong chronic disorders arising from interactions among genetic, immunological and environmental factors. Although the origin of IBDs is closely linked to immune response alterations, which governs most medical decision-making, recent findings suggest that gut microbiota may be involved in IBD pathogenesis. Epidemiologic evidence and several studies have shown that a dysregulation of gut microbiota (i.e., dysbiosis) may trigger the onset of intestinal disorders such as IBDs. Animal and human investigations focusing on the microbiota-IBD relationship have suggested an altered balance of the intestinal microbial population in the active phase of IBD. Rigorous microbiota typing could, therefore, soon become part of a complete phenotypic analysis of IBD patients. Moreover, individual susceptibility and environmental triggers such as nutrition, medications, age or smoking could modify bacterial strains in the bowel habitat. Pharmacological manipulation of bowel microbiota is somewhat controversial. The employment of antibiotics, probiotics, prebiotics and synbiotics has been widely addressed in the literature worldwide, with the aim of obtaining positive results in a number of IBD patient settings, and determining the appropriate timing and modality of this intervention. Recently, novel treatments for IBDs, such as fecal microbiota transplantation, when accepted by patients, have shown promising results. Controlled studies are being designed. In the near future, new therapeutic strategies can be expected, with non-pathogenic or modified food organisms that can be genetically modified to exert anti-inflammatory properties.

Keywords: Intestinal microbiota; Inflammatory bowel diseases; Probiotics; Prebiotics; Symbiotics

Core tip: This paper focuses on the scientific scenario regarding the potential function of gut microbiota in inflammatory bowel diseases (IBDs). Epidemiologic findings suggest that the heterogeneity and disruption of gut microbiota can be significant in modulating and addressing the immune reactions underlying IBD pathogenesis. Traditional or innovative manipulation strategies of gut microbiota may be possible future treatment options for the management of these disorders.