The duodenal microbiome in health and disease: composition and dynamics in relation to the bile salt pool, mucosal physiology and therapy in functional and inflammatory disorders of the duodenum.
The human intestinal microbiome is now widely recognized as a key contributor to human health but the presence of a proximal small intestinal or duodenal microbiome remains largely understudied. Recently, an altered duodenal bile salt pool and mucosal barrier function with immune activation have been reported in functional dyspepsia or the most common cause of epigastric symptoms with normal endoscopy. Small intestinal barrier defects have also been associated with disease relapse and ongoing symptoms despite endoscopic remission in patients with Crohn’s disease, which can also affect the duodenum. However, the probable link between the duodenal microbiome and changes in bile salts and mucosal physiology remains unclear.
In this project, we aim to characterize the mucosal and luminal microbiota of healthy volunteers and patients with functional (functional dyspepsia) and organic (Crohn’s disease) disorders of the duodenum. We will study the effect of acid suppression on the duodenal microbiota, bile salts and mucosal physiology in healthy volunteers and functional dyspepsia patients. This may provide additional arguments not to initiate or continue acid-suppressive therapy, which is important regarding potential side-effects and the cost on the healthcare budget. We will also study the effect of anti-inflammatory therapy on duodenal microbiota in Crohn’s disease patients with and without inflammatory duodenal lesions, as inflammation per se may also affect the microbiome.