The Role of Leaky Gut in Functional Dyspepsia.

Patients with functional dyspepsia (FD) complain of epigastric symptoms with no identifiable cause. Increased intestinal permeability has been described in these patients, especially in the proximal small bowel or duodenum, and was associated with mucosal immune activation and symptoms. In this review, we discuss duodenal barrier function, including techniques currently applied in FD research. We summarize the available data on duodenal permeability in FD and factors associated to increased permeability, including mucosal eosinophils, mast cells, luminal and systemic factors. While the increased influx of antigens into the duodenal mucosa could result in local immune activation, clinical evidence for a causal role of permeability is lacking in the absence of specific barrier-protective treatments. As both existing and novel treatments, including proton pump inhibitors (PPI) and pre- or probiotics may impact duodenal barrier function, it is important to recognize and study these alterations to improve the knowledge and management of FD.

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Copyright © 2022 Wauters, Ceulemans, Schol, Farré, Tack and Vanuytsel.

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LW reports financial support for research from Danone and MyHealth; has served on the advisory board of Naturex; has served on the Speaker bureau for Dr. Falk Pharma, Takeda and MyHealth. TV reports financial support for research from Danone, MyHealth, Takeda and VectivBio; has served on the Speaker bureau for Abbott, Dr. Falk Pharma, Fresenius Kabi, Menarini, Remedus, Takeda, Truvion, and VectivBio; reports consultancy fees from Baxter, Dr. Falk Pharma, Takeda, VectivBio, and Zealand Pharma. JT has given Scientific advice to Adare, AlfaWassermann, Arena, Bayer, Christian Hansen, Clasado, Danone, Devintec, Falk, FitForMe, Grünenthal, Ironwood, Janssen, Kiowa Kirin, Menarini, Mylan, Neurogastrx, Neutec, Novartis, Nutricia, Reckitt Benckiser, Ricordati, Shionogi, Takeda, Truvion, Tsumura, Zealand, and Zeria pharmaceuticals, has received research support from Biohit, Shire, Sofar, and Takeda, and has served on the Speaker bureau for Abbott, Allergan, AstraZeneca, FitForMe, Janssen, Kyowa Kirin, Mayoly, Menarini, Mylan, Novartis, Schwabe Parmaceuticals, Takeda, Wellspect, and Zeria. All the fundings reported were outside of this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.