AGA-Rome Foundation Lectureship: Do Changes in Intestinal Permeability Translate into Clinical Symptoms and Treatments in Disorders of Gut-Brain Interaction?

Society: AGA

Disorders of gut-brain interaction (DGBI), including irritable bowel syndrome (IBS) and functional dyspepsia (FD), are among the most common gastrointestinal (GI) disorders seen in primary care and GI practices. The pathophysiology is multifactorial and not well understood. However, there is increasing evidence that patients with IBS (particularly post-infection IBS [PI-IBS] and IBS with diarrhea) and FD have increased intestinal permeability. Based on various methods of measuring intestinal permeability, there is altered expression of tight junction proteins in the small intestine and colon in patients with DGBI. Increased permeability has been associated with abdominal pain severity, visceral hyperalgesia, and overall symptom severity in IBS. Furthermore, alterations in mucosal barrier function appears to play a role in the interaction between stress, visceral hypersensitivity, altered immune function and gut microbiota in DGBI. A recent study demonstrated altered host–microbial interaction that results in increased gut protease activity that disrupts intestinal barrier function and generates visceral hypersensitivity. From a clinical practice perspective, there is growing evidence that GI symptoms correlate with alterations in intestinal permeability, that some efficacious treatments in DGBI target normalization of intestinal permeability, and that there are various methods of measuring intestinal permeability in clinical practice (and in research). These topics will be reviewed in this session.