Microbiome and gastroesophageal disease: Pathogenesis and implications for therapy

Abstract

There is growing evidence that gastroesophageal disease is significantly influenced by the microbiome of the esophagus. Additionally, the commensal microbiome of the oropharynx, stomach, and colon have a role in its pathogenesis. Changes to the composition of the normal esophageal flora, notably a transition from Grampositive to predominantly Gram-negative, is thought to promote disease susceptibility. Diseases of the esophagus, which include gastroesophageal reflux, Barrett's esophagus, esophageal cancer, esophageal dysmotility, as well as eosinophilic esophagitis. These are all characterized by an inflammatory-mediated cascade thought to be propagated, in part, potentially by an imbalance of commensal microbes.In addition to activation of the inflammatory cascade, potentiation of dysbiosis itself may be a consequence of dysbiotic changes in bacterial composition. Bacteriocins are inhibitory polypeptides produced by bacteria, which may play an integral role in further progression to dysbiotic states by inhibiting growth of commensal flora. Accordingly, this may present an avenue for disease mitigation by shifting the composition of the microbial community towards an eubiotic state.Therapeutic options targeting the microbiome, including prebiotics, probiotics, antibiotics, as well as bacteriocins have been studied. This review focuses on the current knowledge of the involvement of the microbiome in esophageal diseases (most notably GERD/Barrett's esophagus/esophageal cancer) and identifies emerging new concepts for treatment.

Efficacy of a Food Supplement Containing Lactobacillus acidophilus LA14, Peptides, and a Multivitamin Complex in Improving Gastroesophageal Reflux Disease-Related Outcomes and Quality of Life of Subjects Showing Mild-to-Moderate Gastroesophageal Reflux Disease

“…In recent years, research has increasingly focused on identifying and characterizing the role of the human microbiota in the development of functional gastrointestinal disorders (FGIDs), with particular attention to GERD [ 14 , 15 ]. There is increasing evidence that both the onset and progression of GERD are influenced by the composition of the oesophageal microbiota and that commensal bacteria from the oropharynx, stomach, and colon play a role in modulating the pathogenesis of this disease [ 16 ]. These emerging hypotheses are based on observed changes in the composition of the oesophageal microbiota of subjects with GERD compared to healthy subjects [ 17 ].…”

“…In fact, taxonomic analyses have shown that in the healthy oesophagus, there is an abundance of Gram+ bacteria, while in the reflux oesophagus, Gram- bacteria predominate [ 18 ]. This imbalance towards a microbial population characterized by Gram- bacteria is associated with an increase in the antigenic potential of lipopolysaccharide (LPS), a bacterial component that is responsible for the inflammation of the oesophageal mucosa and the compression of the lower oesophageal sphincter, resulting in the relaxation of the latter and in the consequent increase in gastric acid contents in the oesophagus [ 16 ].…”