Microbiome of the Aerodigestive Tract in Health and Esophageal Disease
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MENTORED REVIEW
Microbiome of the Aerodigestive Tract in Health and Esophageal Disease Aws Hasan1 · Laith K. Hasan2 · Bernd Schnabl1 · Madeline Greytak1 · Rena Yadlapati1 Received: 13 August 2020 / Accepted: 15 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The diverse human gut microbiome is comprised of approximately 40 trillion microorganisms representing up to 1000 different bacterial species. The human microbiome plays a critical role in gut epithelial health and disease susceptibility. While the interaction between gut microbiome and gastrointestinal pathology is increasingly understood, less is known about the interaction between the microbiome and the aerodigestive tract. This review of the microbiome of the aerodigestive tract in health, and alterations in microbiome across esophageal pathologies highlights important findings and areas for future research. First, microbiome profiles are distinct along the aerodigestive tract, spanning the oral cavity to the stomach. In patients with reflux-related disease such as gastro-esophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma, investigators have observed an overall increase in gram negative bacteria in the esophageal microbiome compared to healthy individuals. However, whether differences in microbiome promote disease development, or if these shifts are a consequence of disease remains unknown. Interestingly, use of proton pump inhibitor therapy is also associated with shifts in the microbiome, with distinct shifts and patterns along the aerodigestive tract. The relationship between the human gut microbiome and esophageal pathology is a ripe area for investigation, and further understanding of these pathways may promote development of novel targets in prevention and therapy for esophageal diseases. Keywords Gastroesophageal reflux disease · Barrett’s esophagus · Eosinophilic esophagitis Abbreviations BE Barret esophagus EAC Esophageal adenocarcimoma GERD Gastroesophageal reflux disease PPI Proton pump inhibitor EOE Eosinophilic esophagitis
Introduction The human microbiome plays a critical role in gut epithelial health and disease susceptibility, and over the past decade interest in the human microbiome, particularly the gut * Rena Yadlapati [email protected] 1
Division of Gastroenterology, UCSD Center for Esophageal Diseases, University of California, San Diego School of Medicine, 9500 Gilman Drive MC 0956, La Jolla, CA 92093, USA
Tulane University School of Medicine, New Orleans, LA, USA
2
microbiome, has rapidly grown. The human gut microbiome has approximately 40 trillion microorganisms, mostly compromised of about 500–1000 different bacterial species [1]. Within the gastrointestinal tract, the oral cavity, esophagus, stomach, and intestines contain diverse and host-specific microbiomes. The microbiome benefits their human host in a variety of ways including digestion, immune system responses, metabolism, and vitamin production [2–4]. Emphasis has grown on studying
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