Microscopic colitis-microbiome, barrier function and associated diseases

Area of Science:

• Gastroenterology
• Immunology
• Microbiome Research

Background:

• Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by subtle mucosal inflammation, often missed by standard endoscopy.
• MC predominantly affects middle-aged to older females and is frequently linked to other autoimmune conditions.
• The exact pathogenesis of MC is complex and multifactorial, involving intricate interactions between the immune system, gut microbiome, and barrier function.

Purpose of the Study:

• To review current understanding of microscopic colitis pathogenesis.
• To highlight the role of intrinsic and extrinsic factors in modulating the gut microbiome and MC development.
• To discuss the utility of advanced endoscopic techniques in evaluating MC patients and stratifying them for novel therapies.

Main Methods:

• Review of basic and clinical studies utilizing molecular techniques.
• Analysis of data from advanced endoscopic imaging, including capsule endoscopy and confocal endomicroscopy.
• Integration of findings on hormonal, NSAID, and PPI influences on the gastrointestinal microbiome.

Main Results:

• Current concepts implicate innate immunity, microbiome alterations, and gut barrier dysfunction in MC pathogenesis.
• Both intrinsic (e.g., hormonal) and extrinsic (e.g., NSAIDs, PPIs) factors significantly modulate the gastrointestinal microbiome and contribute to MC.
• Advanced endoscopic tools offer improved diagnostic capabilities and patient stratification.

Conclusions:

• Understanding the multifactorial pathogenesis of MC is crucial for developing effective treatments.
• Modulating the gut microbiome and enhancing gut barrier function represent promising therapeutic strategies for MC.
• Novel endoscopic imaging techniques enhance the evaluation and management of microscopic colitis patients.