Search

Gut microbiota research has rapidly evolved, but has yet to translate fully to the clinic. In this Perspectives, Eamonn Quigley explores whether the gut microbiota could be used as a clinical tool in gastrointestinal disease, providing a note of caution to the hype.

Five of our Advisory Board Members—international experts across different subspecialties—reflect on the progress and frustrations of the past 10 years in gastroenterology and hepatology. They also comment on where effort and money should be invested now, as well as their predictions for progress in the next 10 years.

Global differences in drug regulation might influence the availability of drugs for the treatment of irritable bowel syndrome in Europe. The author of this Viewpoint explores the role of drug regulation in the context of the difficulties faced in achieving therapeutic success in this challenging area.

Any worthwhile guideline must be evidence-based, or should it? Evidence for the construction of guidelines often comes from clinical trials that are performed in the West according to the priorities and goals of that population and those of the pharmaceutical industry whose resources are relied upon to perform such trials. This Viewpoint article discusses the development of guidelines using an evidence-based approach and whether this approach is applicable worldwide.

Clinical Guidelines are primarily developed in the affluent West. This Viewpoint article discusses whether these guidelines are really useful and relevant to resource-poor, developing countries, and whether attempts to adhere to such guidelines obscure more fundamental issues such as the provision of basic health care. The authors argue that if guidelines are adapted to local resources and needs, and employ a 'cascade' approach they can work.

Evidence-based guidelines from wealthy countries define optimum goals for resource-constrained countries. This Viewpoint article discusses how health-care policy in developing countries can only be influenced through local involvement in the construction and implementation of guidelines. The authors also discuss the potential yet controversial role of the biomedical industry in facilitating the development and dissemination of global guidelines.

The gut microbiota is implicated in the etiology of nonalcoholic fatty liver disease (NAFLD) as well as progression to the more severe nonalcoholic steatohepatitis. Evidence supporting this role is mainly from animal models, although data from human studies are also emerging. In this Review, the authors provide an overview of the gut–liver interactions that contribute to the pathogenesis of NAFLD and propose that modification of the gut microbiota by prebiotics or probiotics could be a potentially important therapeutic strategy.

This Perspective discusses misconceptions and controversies in the clinical management of irritable bowel syndrome (IBS), including diagnosis, testing and treatment, among others. Areas in which issues have been resolved and those that require further research and clarification are highlighted.

Although GERD and functional dyspepsia are generally thought of as completely distinct disorders with unique symptoms and treatments, they are, in many ways, more similar than different and can overlap in the same individual. This Review, which focuses on the overlap of GERD with functional dyspepsia, describes similarities and differences with regards to the epidemiology, pathophysiology, diagnosis and treatment of these two disorders.

Increased knowledge of the gut microbiota will be key to understanding its role in health and disease. This Review presents the techniques currently used to characterize the gut microbiota. The authors explain the various methods—from culture through to microbiome shotgun sequencing—suggesting when they can be most appropriately applied to human studies, and also critically reviewing their advantages and limitations as a guide to clinicians.

Small intestinal bacterial overgrowth (SIBO) has been linked to common gastrointestinal symptoms; yet its precise definition remains elusive. A new study shows that, when it comes to symptom prediction in functional gastrointestinal disorders, high-throughput sequencing analysis of the microbiome and not jejunal aspiration and culture is the clear winner.

The pathophysiology of IBS is poorly understood. Epidemiological studies point to risk factors such as familial clustering, sexual abuse and other forms of childhood trauma, low birth weight and gastrointestinal infection. Epigenetics focuses on the interaction between DNA sequence, DNA modifications and environmental factors to produce a phenotype. In this Perspective, Dinan and colleagues present an epigenetic model of IBS. Applying epigenetic methodology to IBS may help unravel its pathophysiology and lead to more effective treatments.

Postbiotics are emerging substances prepared from inactivated microorganisms, in contrast to probiotics, which must be administered alive. This Consensus Statement outlines a definition for the term ‘postbiotics’ as determined by an expert panel convened by the International Scientific Association for Probiotics and Prebiotics.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high prevalence. Enck et al. describe the association between IBS and other gastrointestinal, somatic and psychiatric conditions, as well as the current view on the pathophysiology, and diagnostic and management options.