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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2020; 8(6): 1013-1025
Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1013
Microbiota-gut-brain axis and its affect inflammatory bowel disease: Pathophysiological concepts and insights for clinicians
Emanuele Sinagra, Erika Utzeri, Gaetano Cristian Morreale, Carlo Fabbri, Fabio Pace, Andrea Anderloni
Emanuele Sinagra, Gastroenterology and Endoscopy Unit, Fondazione Istituto Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, Cefalù 90015, Italy
Emanuele Sinagra, Euro-Mediterranean Institute of Science and Technology, Palermo 90100, Italy
Erika Utzeri, Nuova Casa di Cura di Decimomannu, Cagliari 09100, Italy
Gaetano Cristian Morreale, Section of Gastroenterology, S. Elia-Raimondi Hospital, Caltanissetta 93100, Italy
Carlo Fabbri, Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, Azienda USL Romagna, Forlì 47121, Italy
Fabio Pace, Unit of Gastroenterology, Bolognini Hospital, Bergamo 24100, Italy
Andrea Anderloni, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano 20089, Italy
Author contributions: Sinagra E designed the study; Sinagra E, Utzeri E, and Morreale GC wrote the paper; Pace F and Jones R contributed to the revision of the manuscript; Anderloni A supervised the work.
Conflict-of-interest statement: All the authors declare that this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors, and thus there is no conflict of interest regarding this paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Emanuele Sinagra, MD, PhD, Doctor, Gastroenterology and Endoscopy Unit, Fondazione Istituto Giuseppe Giglio, Contrada Pietra Pollastra Pisciotto, Cefalù 90015, Italy. emanuelesinagra83@googlemail.com
Received: December 30, 2019
Peer-review started: December 30, 2019
First decision: January 19, 2020
Revised: February 14, 2020
Accepted: March 5, 2020
Article in press: March 5, 2020
Published online: March 26, 2020
Processing time: 86 Days and 10.2 Hours
Abstract

Despite the bi-directional interaction between gut microbiota and the brain not being fully understood, there is increasing evidence arising from animal and human studies that show how this intricate relationship may facilitate inflammatory bowel disease (IBD) pathogenesis, with consequent important implications on the possibility to improve the clinical outcomes of the diseases themselves, by acting on the different components of this system, mainly by modifying the microbiota. With the emergence of precision medicine, strategies in which patients with IBD might be categorized other than for standard gut symptom complexes could offer the opportunity to tailor therapies to individual patients. The aim of this narrative review is to elaborate on the concept of the gut-brain-microbiota axis and its clinical significance regarding IBD on the basis of recent scientific literature, and finally to focus on pharmacological therapies that could allow us to favorably modify the function of this complex system.

Keywords: Irritable bowel syndrome; Inflammatory bowel disease; Gut-brain axis; Therapy

Core tip: The complex interplay between gut microbiota and the brain, and vice versa, has recently become not only the focus of neuroscience, but also the start point for research regarding many diseases such as inflammatory bowel diseases (IBD) and irritable bowel syndrome. The bi-directional interaction between gut microbiota and the brain is not completely understood. Nonetheless, there is increasing evidence arising from animal and human studies that show how this intricate relationship may contribute to the pathogenesis of IBD, with consequent important implications for the possibility to improve the clinical outcomes of the diseases themselves by acting on the different components of this axis. With the emergence of precision medicine, strategies in which patients with IBD might be categorized other than for standard gut symptom complexes could offer the opportunity to tailor therapies to individual patients.