Treatment of dysbacteriosis for diseases of the esophagus

Post by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

Treatment of dysbacteriosis for esophageal diseases such as reflux esophagitis, ... and other related diseases through supplementing prebiotics, probiotics and antibiotics. Thereby helping to reduce dysbacteriosis, improving the ratio of gram-positive to gram-negative for esophageal diseases.

Reports have shown that complementary treatment options such as prebiotics, probiotics and antibiotics have been studied to reduce dysbiosis by directly or indirectly improving the gram-positive to gram-negative ratio for esophageal disease.
1.1. Prebiotics Supplements that increase concentrations of beneficial flora have been studied. Lactobacillus spp,...found in the esophagus, metabolizes maltosyl-isomaltooligosaccharides (MIMO), thereby enhancing the favorable gram-positive organism population. Taking MIMO daily has been reported to improve or eliminate symptoms in patients with chronic reflux esophagitis.
An ongoing tolerability study (NCT04491734) and a comprehensive multicenter randomized placebo-controlled study will begin in early 2021. Sugarcane powder has also been evaluated as a prebiotic with several benefits were seen in one study. The proposed mechanism of benefit is slower fermentation and therefore higher availability compared to traditional fiber products
1.2. Probiotics Probiotics supplemented with strains of bacteria as dietary supplements, attempting to improve the gut microbial composition to a state of preference. Probiotics containing Lactobacilli spp. and Bifidobacteria spp. has been evaluated and shown to reduce symptoms of reflux esophagitis. However, the long-term effects and histological benefits have yet to be studied and recent guidelines have suggested that there is no evidence of recovery based on regular use. Further investigation is needed to evaluate the potential efficacy of probiotics in esophageal diseases.

1.3. Antibiotics Antibiotics are a potential therapeutic option for direct modification of esophageal microbiota and are widely used in the treatment of gastrointestinal infectious diseases. Antibiotics with bioavailability focused on the gut have been used to treat small intestinal bacterial overgrowth, hepatic encephalopathy, and infections caused by Clostridium difficile. However, there is no evidence for the efficacy of antibiotic use for esophageal dysbiosis in reflux esophagitis, Barrett's esophagus, or adenocarcinoma of the esophagus.
1.4. Bacteriocins Bacteriocins facilitate competition between local and foreign bacteria, have direct microbial properties, have the potential to cross the blood-intestinal barrier, and have antitumor properties. Bacterial-based drug therapy, whether in the form of targeted drug therapy through encapsulation or the attachment of microbes to polymer-based macromolecules, metals or nanoparticles, remains a field is being studied.

Esophageal microbiota plays a major role in the pathogenesis of esophageal disease. Various factors can affect the composition of the synaptic flora, which can lead to dysbiosis and ultimately to esophageal diseases. Biologic disturbances may contribute to a proinflammatory, cytokine-mediated state that begins in the submucosa. The pathogenic effect, which affects the esophageal mucosa, was previously thought to be caused by acid-induced mucosal damage, but now appears to be multifactorial, with esophageal microbiota playing a major role. Specific flora has recently been identified that may play a pathogenic role in this process. Several potential approaches to treating altered microbiota exist, including prebiotics, probiotics, antibiotics, and bacteria-based therapies.
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