Synopsis of the course

Does the microbiota affect GI symptoms? The answer is yes, as largely demonstrated in the literature. But then, can we use the microbiota to treat GI symptoms? Join Dr. Eamonn Quigley in this review of the most recent and interesting data on the interaction between the microbiota and GI symptoms. We will review the effects of the microbiome on upper, and lower GI symptoms (focusing on IBS), bowel habit, bloating, flatulence, and distension, and we will get some practical tips to provide the best care to our patients with GI symptoms. Are you going to miss it?

Who is Eamonn Quigley?

• Eamonn Quigley, MD, FRCP, FACP, MACG, FRCPI, MWGO, gastroenterologist, David M. Underwood Chair of Medicine in Digestive Disorders, chief of the Division of Gastroenterology and Hepatology, and a Professor of Medicine at Weill Cornell Medical College at Houston Methodist Hospital.
• He was President of the World Gastroenterology Organisation from 2005 to 2009 and President of the American College of Gastroenterology from 2008 to 2009. He was Editor-in-Chief of The American Journal of Gastroenterology from 1997 to 2003. He has published more than 800 peer-reviewed articles, reviews, editorials, book chapters and case reports, mostly in the areas of gut motility, functional gastrointestinal disorders, and GERD.
• Conflicts of Interest Statement: The author reports receiving grants/research supports from 4D Pharma, Biomerica, and Vibrant, receiving honoraria or consultation fees from Novozymes, Biocodex, Preciosionbiotics, and Salix, and participating in a speaker's bureau sponsored by Biocodex.

What is Xpeer?

Xpeer Medical Education is the first accredited medical education app in the market, with video microlearning engaging videos of just 5 minutes.

With a powerful algorithm to personalize the user experience and the contents as the most popular entertaining streaming platforms, it offers a brand new experience for the continuing education and professional development of the healthcare professionals.

Accredited by the European Union of Medical Specialists, it delivers high quality scientific medical education pieces. On Xpeer, you will find this curriculum on Microbiota and 500 hours of medical education in 2021 in your specialty, technologies and professional and personal skills.

Information on accreditation

The app Xpeer is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide official ECMEC credits recognized officially in 26 countries.

The credits for the users of the module will be 1 European CME credit (ECMEC®) for every hour (60 minutes of actual e-learning excluding introductions etc.) of use, provided that the users have completed a module and have passed the relevant assessment.

Recommended by our community

Synopsis of the course

• In the last years, more and more discoveries have shed light into the complex interaction between the gut microbiota and its human host. Its influence, although still not fully understood, ranges from helping defend against pathogens, and help digest otherwise indigestible foods, to maintain the gut barrier integrity, but also modulate human health and metabolism. This last one is particularly important because more recent studies have suggested that the gut microbiota may be implicated in metabolic diseases such as obesity and diabetes. 
• Obesity is a complex disease and can have major consequences on health. Obesity was recently recognized as a chronic disease by The European Commission in March 2021. Then, in this course you will explore some studies which give some clue of the role of gut microbiota in human biology. Moreover, this course will give you an in-depth review of the importance of gut microbiota diversity and composition, and its relationship with different metabolic disorders, but also its variations between cultures, ethnicities and lifestyles. In this course you will understand to the molecular level how the gut microbiota affects the host biology, through its involvement in the intestinal structure and integrity, food digestion, and production of many metabolites. Finally, you will acquire the skills to better integrate the gut microbiota aspects into your clinical practice, and the knowledge of how it can be beneficial for your patients.

Who is Pr Karine Clément?

• Pr Karine Clément, MD, PhD, is full professor of Nutrition at University Pierre and Marie Curie, Pitié-Salpétrière Hospital in Paris. She is the former director (2011-2017) of the Institute of Cardio-Metabolism and Nutrition (ICAN) and of an INSERM/university team called “NutriOmics”. Her team works on several aspects of the complex pathophysiology of human obesity, particularly exploring tissue alterations (such as adipose tissue depots, liver, intestine), modified cross-talks and links with comorbidities during human obesity progression and weight loss.
• Pr Karine Clements’ team investigated gut microbiota changes induced by dietary changes and bariatric surgery and described significant modifications of bacterial gene richness, bacterial groups and links with metabolic and inflammation phenotypes related to obesity. She published more than 300 papers in the field.
• She is member and expert of several national and international scientific committees in obesity and metabolism and contributes to several European Networks. She coordinates METACARDIS a European program on gut microbiota and cardiometabolic.

What is Xpeer?

Xpeer Medical Education is the first accredited medical education app in the market, with video microlearning engaging videos of just 5 minutes.

With a powerful algorithm to personalize the user experience and the contents as the most popular entertaining streaming platforms, it offers a brand new experience for the continuing education and professional development of the healthcare professionals.

Accredited by the European Union of Medical Specialists, it delivers high quality scientific medical education pieces. On Xpeer, you will find this curriculum on Microbiota and 500 hours of medical education in 2021 in your specialty, technologies and professional and personal skills.

Information on accreditation

The app Xpeer is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide official ECMEC credits recognized officially in 26 countries.

The credits for the users of the module will be 1 European CME credit (ECMEC®) for every hour (60 minutes of actual e-learning excluding introductions etc.) of use, provided that the users have completed a module and have passed the relevant assessment.

Synopsis of the course

Explore the intricate relationship between antibiotics and the human microbiome in this CME course, updated with the latest evidence in the field. Providing you with a more practical approach, the course now includes a clinical case revealing the profound impact of antibiotic therapy on gut health, and how relevant the knowledge acquired in this course will be to your clinical practice.

Understand how dysbiosis, characterized by microbial imbalance, underpins various gastrointestinal and systemic disorders.

Updated with cutting-edge research, discover novel insights into antibiotic-associated dysbiosis and its far-reaching consequences on patient health. Equip yourself with evidence-based strategies to mitigate dysbiosis-related complications and optimize patient outcomes. Join us to navigate the evolving landscape of drug-microbiome interactions in clinical practice.

Who is professor Guarner ?

• Francisco Guarner, MD, PhD. has a degree in Medicine and Surgery and specialized in Digestive Diseases.
• He carries out his professional activity in the Digestive Pathology Service of the Universitari Vall d'Hebró Hospital.
• He has been a research fellow at the Liver United at Kings College Hospital in London and a research fellow in the Prostaglandin Research department of Welcome Research Laboratories.
• He is currently a member of the Centre of Network Biomedical Research of hepatic and digestive diseases as principal investigator of the inflammatory bowel diseases group and a member of the Board of Directors of the International Scientific Association for Probiotics and Prebiotics.
• He is also president of the Board of Directors of the Probiotics and Prebiotics Spanish Society, member of the Guidelines & Publications Committee of WGO-OMGE (World Gastroenterology Organization) and member of the Steering Committee of the International Human Microbiome Consortium (IHMC).

Conflict of Interest Disclosure: Francisco Guarner receives research funding from Abbvie, Takeda and AB-Biotics, and consulting fees from the Danone Institute, Sanofi, Biocodex, Actial, Menarini and Ordesa.

What is Xpeer?

Xpeer Medical Education is the first accredited medical education app in the market, with video microlearning engaging videos of just 5 minutes.

With a powerful algorithm to personalize the user experience and the contents as the most popular entertaining streaming platforms, it offers a brand new experience for the continuing education and professional development of the healthcare professionals.

Accredited by the European Union of Medical Specialists, it delivers high quality scientific medical education pieces. On Xpeer, you will find this curriculum on Microbiota and 500 hours of medical education in 2021 in your specialty, technologies and professional and personal skills.

Information on accreditation

The app Xpeer is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide official ECMEC credits recognized officially in 26 countries.

The credits for the users of the module will be 1 European CME credit (ECMEC®) for every hour (60 minutes of actual e-learning excluding introductions etc.) of use, provided that the users have completed a module and have passed the relevant assessment.

With the practicality of an app, yet, with the expertise of scientists, you can get AMA or EACCME credits.

How can I access the curriculum on Microbiota?

Available now on the app!

What is Xpeer?

Xpeer Medical Education is the first accredited medical education app in the market, with video microlearning engaging videos of just 5 minutes.

With a powerful algorithm to personalize the user experience and the contents as the most popular entertaining streaming platforms, it offers a brand new experience for the continuing education and professional development of the healthcare professionals.

Accredited by the European Union of Medical Specialists, it delivers high quality scientific medical education pieces. On Xpeer, you will find this curriculum on Microbiota and 500 hours of medical education in 2021 in your specialty, technologies and professional and personal skills.

Information on accreditation:

The app Xpeer is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide official ECMEC credits recognized officially in 26 countries.

The credits for the users of the module will be 1 European CME credit (ECMEC®) for every hour (60 minutes of actual e-learning excluding introductions etc.) of use, provided that the users have completed a module and have passed the relevant assessment.

Are we destined to keep our extra pounds?

Broadly speaking, belief in a miracle cure is delusional. No treatment can beat obesity without the active participation of the subjects (diet, exercise, etc.) and an integrated and personalized approach to their care. Obesity is a long-term complex condition that depends on multiple related factors, including gut microbiota. However, to claim that an imbalance (sidenote: Dysbiosis Generally defined as an alteration in the composition and function of the microbiota caused by a combination of environmental and individual-specific factors. Levy M, Kolodziejczyk AA, Thaiss CA, et al. Dysbiosis and the immune system. Nat Rev Immunol. 2017;17(4):219-232.   ) in the microbial ecosystem inevitably leads to obesity (or conversely that a balanced one ensures a normal weight) is a mistake. It is nonetheless a good idea to maintain a balanced gut microbiota, which is part of a comprehensive and personalized treatment for patients.

Is it risky to act on microbiota on one’s own?

From a strictly medical standpoint, the approach is relatively safe, provided that consumers choose a probiotic¹⁷ whose advanced effects are based on scientific proof and whose bacterial composition is known (Lactobacilli (sidenote: Lactobacilli Rod-shaped bacteria whose main characteristic is the production of lactic acid, from where they get the name “lactic acid bacteria”.  Lactobacilli are present in the oral, vaginal and gut microbiota of humans, but also in plants and animals. They are found in fermented foods, such as dairy products (e.g. certain cheeses and yoghurts), pickles, sauerkraut, etc. Lactobacilli are also found in probiotics, with certain species recognized for their beneficial properties.   W. H. Holzapfel et B. J. Wood, The Genera of Lactic Acid Bacteria, 2, Springer-Verlag, 1st ed. 1995 (2012), 411 p. « The genus Lactobacillus par W. P. Hammes, R. F. Vogel Tannock GW. A special fondness for lactobacilli. Appl Environ Microbiol. 2004 Jun;70(6):3189-94. Smith TJ, Rigassio-Radler D, Denmark R, et al. Effect of Lactobacillus rhamnosus LGG® and Bifidobacterium animalis ssp. lactis BB-12® on health-related quality of life in college students affected by upper respiratory infections. Br J Nutr. 2013 Jun;109(11):1999-2007. ) and Bifidobacteria (sidenote: Bifidobacterium A genus of Y-shaped bacteria, most species of which are beneficial to humans. They are found in the gut of humans, and in some yogurts.

They:
- Protect the gut barrier 
- Participate in the development of the immune system and help fight inflammation 
- Promote digestion and improve symptoms of gastrointestinal disorders Sung V, D'Amico F, Cabana MD, et al. Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20171811.  O'Callaghan A, van Sinderen D. Bifidobacteria and Their Role as Members of the Human Gut Microbiota. Front Microbiol. 2016 Jun 15;7:925. Ruiz L, Delgado S, Ruas-Madiedo P, et al. Bifidobacteria and Their Molecular Communication with the Immune System. Front Microbiol. 2017 Dec 4;8:2345. ) for example). It is a myth to think that all probiotics are the same as the specific bacterial strain used plays a critical role in their action. Lastly, the consumption of prebiotics¹⁸ should also be encouraged. However, new users should particularly avoid taking excessively high doses as they might experience unpleasant side effects such as bloating, diarrhea, abdominal pain, etc. If truth be told, the greatest risk is a psychological one—namely being disappointed if promises are broken!

Has gut microbiota transplant been oversold?

Many studies are currently underway on the topic. Some of them show that transplanting microbiota would have no effect on obesity or that it would result in a temporarily improved ability to stabilize blood sugar levels. Results have been disappointing, but provided much valuable information. We now know that donor and recipient microbiota must be compatible. We have also learned that some individuals are more receptive than others to transplant (the same goes for dietary changes) depending on the initial composition of their microbiota. In any event, improving our health by focusing on gut microbiota is a promising avenue, as long as we act reasonably and follow medical and dietary recommendations. Personally, I am convinced of it as my motto is “In Gut We Trust”.

Fecal microbiota transplant (FMT), also known as stool transplant, is another method which may well prove promising¹⁶. Currently prescribed to treat a sole condition far removed from obesity (recurrent Clostridium difficile infections), the procedure consists in this case in transferring microorganisms (sidenote: Microorganisms Living organisms that are too small to be seen with the naked eye. They include bacteria, viruses, fungi, archaea and protozoa, and are commonly referred to as “microbes”. What is microbiology? Microbiology Society. ) contained in the stool of donors with normal BMI to obese recipients to “correct” their flora¹⁷.

Several research teams are currently exploring the potential value of this approach. They are thoroughly examining its effect on gut microbiota restoration, eating behavior and the proper use of energy resources based on calories consumed¹⁷.

It’s the same story for prebiotics. These non-digestible sugars— present in vegetables, whole-grain cereals, legumes, tubers, fruits, nuts, herbs, spices, etc.—nourish good bacteria allowing them to proliferate to the detriment of bad bacteria. While their benefits in combating obesity have been widely demonstrated in the laboratory, human studies have produced divergent results⁶.

Some prebiotics induced a significant reduction in weight, BMI and waist circumference in obese and overweight adults, while others had no effect⁶.

As a whole, studies show that prebiotics affect satiety⁷, but unfortunately this does not lead to weight loss⁶. Although prebiotics remains an exciting line of research, experts agree that it is still too early to recommend their use in treating obesity and excess weight⁶.

To study their effect on weight loss, the body’s ability to regulate blood sugar levels despite a fatty diet, the feeling of satiety, the drop in the body mass index (BMI), the decline in fat mass, etc., laboratory mice were examined from every angle after being fed probiotics^3,4,6,14,15.

One of the results was that some lactobacilli (sidenote: Lactobacilli Rod-shaped bacteria whose main characteristic is the production of lactic acid, from where they get the name “lactic acid bacteria”.  Lactobacilli are present in the oral, vaginal and gut microbiota of humans, but also in plants and animals. They are found in fermented foods, such as dairy products (e.g. certain cheeses and yoghurts), pickles, sauerkraut, etc. Lactobacilli are also found in probiotics, with certain species recognized for their beneficial properties.   W. H. Holzapfel et B. J. Wood, The Genera of Lactic Acid Bacteria, 2, Springer-Verlag, 1st ed. 1995 (2012), 411 p. « The genus Lactobacillus par W. P. Hammes, R. F. Vogel Tannock GW. A special fondness for lactobacilli. Appl Environ Microbiol. 2004 Jun;70(6):3189-94. Smith TJ, Rigassio-Radler D, Denmark R, et al. Effect of Lactobacillus rhamnosus LGG® and Bifidobacterium animalis ssp. lactis BB-12® on health-related quality of life in college students affected by upper respiratory infections. Br J Nutr. 2013 Jun;109(11):1999-2007. ) , bifidobacteria (sidenote: Bifidobacterium A genus of Y-shaped bacteria, most species of which are beneficial to humans. They are found in the gut of humans, and in some yogurts.

They:
- Protect the gut barrier 
- Participate in the development of the immune system and help fight inflammation 
- Promote digestion and improve symptoms of gastrointestinal disorders Sung V, D'Amico F, Cabana MD, et al. Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20171811.  O'Callaghan A, van Sinderen D. Bifidobacteria and Their Role as Members of the Human Gut Microbiota. Front Microbiol. 2016 Jun 15;7:925. Ruiz L, Delgado S, Ruas-Madiedo P, et al. Bifidobacteria and Their Molecular Communication with the Immune System. Front Microbiol. 2017 Dec 4;8:2345. ) , other bacteria with complicated names (Akkermansia, Hafnia, Pediococcus, Bacteroides,etc.) as well as a yeast, came out on top. Mice treated with these probiotics showed an improved metabolic profile and reduced weight gain^6,14,15. One of them even had a promising appetite-suppressant effect and contributed to the feeling of satiety.

There is less data on humans, and only some specific probiotics had an impact on weight, BMI, waist circumference, fat mass and metabolic profile^3,4,6. Despite these encouraging results, more research is needed to find out whether humans respond in the same way^3,6.

Diet is both the leading risk factor for obesity and the main lever in gut microbiota modulation. Unsurprisingly, the composition of the gut is shaped by dietary preferences. For example, omnivores have a higher diversity of bacteria compared to vegetarians. Similarly, microbiota is dominated by certain specific species in consumers of animal fat and protein, etc³. In theory, it seems easy to “remedy”...

Wrong!

Responses vary from person to person. Despite a great number of studies, no direct link has currently been established between action on the flora and the amount of weight loss¹¹. Some researchers believe that initial composition of our gut microbiota explains the variability in responses to diet^7,11 while others feel that it is even a good predictor of success⁷.

Among this controversy, only one thing is certain—healthy eating matters, even if some of us gain weight more easily than others!

The gastrointestinal tract is populated by bacteria, viruses and fungi. Among them, the two dominant bacterial phyla (Bacteroidetes and Firmicutes, including lactobacilli (sidenote: Lactobacilli Rod-shaped bacteria whose main characteristic is the production of lactic acid, from where they get the name “lactic acid bacteria”.  Lactobacilli are present in the oral, vaginal and gut microbiota of humans, but also in plants and animals. They are found in fermented foods, such as dairy products (e.g. certain cheeses and yoghurts), pickles, sauerkraut, etc. Lactobacilli are also found in probiotics, with certain species recognized for their beneficial properties.   W. H. Holzapfel et B. J. Wood, The Genera of Lactic Acid Bacteria, 2, Springer-Verlag, 1st ed. 1995 (2012), 411 p. « The genus Lactobacillus par W. P. Hammes, R. F. Vogel Tannock GW. A special fondness for lactobacilli. Appl Environ Microbiol. 2004 Jun;70(6):3189-94. Smith TJ, Rigassio-Radler D, Denmark R, et al. Effect of Lactobacillus rhamnosus LGG® and Bifidobacterium animalis ssp. lactis BB-12® on health-related quality of life in college students affected by upper respiratory infections. Br J Nutr. 2013 Jun;109(11):1999-2007. ) ) represent nearly 90% of the gut microbiota³. The remaining 10% consists of Proteobacteria (including Escherichia coli, known to be sometimes harmful) and Actinobacteria, including beneficial bifidobacteria (sidenote: Bifidobacterium A genus of Y-shaped bacteria, most species of which are beneficial to humans. They are found in the gut of humans, and in some yogurts.

They:
- Protect the gut barrier 
- Participate in the development of the immune system and help fight inflammation 
- Promote digestion and improve symptoms of gastrointestinal disorders Sung V, D'Amico F, Cabana MD, et al. Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20171811.  O'Callaghan A, van Sinderen D. Bifidobacteria and Their Role as Members of the Human Gut Microbiota. Front Microbiol. 2016 Jun 15;7:925. Ruiz L, Delgado S, Ruas-Madiedo P, et al. Bifidobacteria and Their Molecular Communication with the Immune System. Front Microbiol. 2017 Dec 4;8:2345. ) ³. A well-balanced gut microbiota contributes to good health and a number of processes. It aids digestion and proper intestinal cell function, interacts with the immune system, prevents invading molecules and bacteria from crossing the gut epithelium and also communicates with the brain. In obese and overweight individuals, the gut microbiota seems to be unbalanced (dysbiosis (sidenote: Dysbiosis Generally defined as an alteration in the composition and function of the microbiota caused by a combination of environmental and individual-specific factors. Levy M, Kolodziejczyk AA, Thaiss CA, et al. Dysbiosis and the immune system. Nat Rev Immunol. 2017;17(4):219-232.   ) ). This means it is generally less abundant and diverse⁹ with a reduction of beneficial bacterial species such as Akkermansia muciniphila and bifidobacteria (sidenote: Bifidobacterium A genus of Y-shaped bacteria, most species of which are beneficial to humans. They are found in the gut of humans, and in some yogurts.

They:
- Protect the gut barrier 
- Participate in the development of the immune system and help fight inflammation 
- Promote digestion and improve symptoms of gastrointestinal disorders Sung V, D'Amico F, Cabana MD, et al. Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20171811.  O'Callaghan A, van Sinderen D. Bifidobacteria and Their Role as Members of the Human Gut Microbiota. Front Microbiol. 2016 Jun 15;7:925. Ruiz L, Delgado S, Ruas-Madiedo P, et al. Bifidobacteria and Their Molecular Communication with the Immune System. Front Microbiol. 2017 Dec 4;8:2345. )  and an increase in potentially harmful bacteria that contribute to weight gain through yet-tobe- understood mechanisms.⁹.

The vicious cycle of dysbiosis

Be it the cause or the consequence, gut microbiota plays a role in obesity. When altered, there are many health implications including digestive disorders, impaired defense mechanisms and its reduced capacity to communicate with the brain to control hunger⁸. These disturbances in turn maintain gut microbiota dysbiosis⁹. More than just a metabolic disorder, obesity would therefore be associated with brain and immune system dysfunction which manifests itself in abnormal eating behaviors in which gut microbiota plays a role^3,4,8,10.

Let us explain!