John Damianos, M.D. Profile picture
Aug 27, 2021 43 tweets 24 min read Read on X
While we're beginning to understand more and more about the #microbiome, research on the #mycobiome (fungi 🍄) is in its infancy. Here is my summary of 🔑 points from @aeprobio's seminar on the latest research on fungi and the gut!

#GITwitter

Bacteria in the #gut outnumber fungi as a class, but at the individual species level can occur in the same numbers.
Most #gut fungi belong to Ascomycota or Basidiomycota
The #mycobiome has low evenness, with different individuals having dominant fungal communities
Fungi play important roles in host health and immunity
On the other hand, fungal dysbiosis has been implicated in many disease states, including #IBD.
The future of #mycobiome research
Summary from @PaulineDScanlan
Just as #diet is an important contributor to the #gut #microbiome, diet also modulates the #mycobiome.

More frequent brushing of teeth is associated with ⬇️ gut Candida
Western diet vs vegetarian diet:
Vegetarian diet has greater fungal diversity, and different composition of fungi (e.g. Candida 63% vs 84%). Fusarium and Aspergillus are common plant pathogens.
Most common reported fungal genera. Most are yeast. On a strain level, Candida are most common.
Factors impacting resident gut fungi versus non-resident (environmental) fungi
Dietary fungi, even if not colonizing the gut, probably have a role in host health. For example, Debaromyces hansenii seem to inhibit Candida albicans and C. tropicalis
Summary from @HallenAdams
@JosephPetrosino on the #mycobiome of infants with type 1 #diabetes
Fungal diversity in healthy individuals the #gut is lower than bacterial diversity.
Fungi interact with #gut bacteria.

Can we use this knowledge to develop fungal-based #probiotics to support good bacteria and suppress the bad?
Fascinating large study identifying determinants in the development of type 1 #diabetes
10 distinct bacterial communities in infants. These get more diverse over time.

Breastfeeding, furry pets, siblings, and antibiotics all had significant effects on the development of the #microbiome.
Specific viral infections are associated with the development of type 1 #diabetes.

Enteroviruses (especially B). Infection with adenovirus C within 6 months of birth appears to be protective.
Fungal diversity increases until 2 years of age and then plateaus.
Sex, asthma, breastfeeding, and #probiotics impact fungal composition
Geography also contributes to fungal composition
No differences in Candida abundance in type 1 #diabetes.
Pichia kudriavzevii was not found to be associated with #asthma
Candida sake was associated with #celiac disease, but not C. albicans
Eamonn Quigley on the clinical implications of the #mycobiome. What is the deal with Candida? Is "candida overgrowth" or #SIFO real? Does candidal dysbiosis contribute to #GI symptoms?
Lots of online pseudoscience around "candida overgrowth" claiming that it causes anything and everything, and prescribing "candida killing" diets
Fungal infections in the #GI tract include oropharyngeal and esophageal candidiasis. Immunosuppressed patients predispose to fungal infections.
Candidemia is a potentially life-threatening fungal infection of the blood. This is almost always in immunocompromised hosts.
Critical illness with prolonged use of broad spectrum antibiotics can lead to fungal diarrhea which resolves with nystatin.
What about small intestinal fungal overgrowth (#SIFO)?
In 150 patients with unexplained #GI symptoms (probably DGBIs)
🦠63% had #SIBO or SIFO
🦠Dysmotility was risk factor for SIBO/SIFO
🦠PPI protected against SIFO
❓No evidence that SIBO/SIFO contributed to symptoms
No difference in #mycobiome richness or diversity in #IBS compared to healthy controls, and no difference between IBS subtypes. Minor differences were present.
In another study, #IBS patients were divided into those with and without visceral hypersensitivity. The IBS patients had an altered #mycobiome compared to controls, but VH did not matter. In mice, however, VH was found to be affected by the mycobiome.
Diet is an important contributor to the #mycobiome. Even one bite of bread can ⬆️ gut Saccharomyces!

Brushing teeth 3 (vs 1) times per day ⬇️ gut Candida albicans
Eamonn Quigley summary
Frank Schuren
Fungal dysbiosis may contribute to neurodegenerative diseases
@ISAPPscience seminar!

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More from @john_damianosMD

Mar 14
A master class on prokinetics from @NGMJournal! Here is a summary! 🧵👇

⚡️🎈〽️🪠🫀💩🚄🧠✳️🗯️💊📰🚽🔌🧪💡🧲📊🔎

#MedTwitter #GITwitter #motility #pharmacology

onlinelibrary.wiley.com/doi/full/10.11…
Image
Pyridostigmine & neostigmine
⚡️cholinesterase inhibitors
🧠pyrido should not cross the blood-brain barrier
🚽evidence in chronic idiopathic constipation and acute colonic pseudo-obstruction
🫄pregnancy class C; excreted in breastmilk
🫀cholinergic side effects, esp bradycardia Image
Acotiamide
⚡️inhibits cholinesterase and enhances ACh release via muscarinic receptors
🎈enhances gastric emptying and accommodation
🔥NERD & FD
🫄no safety data
💊side effects: nausea, abdominal distension, constipation Image
Read 20 tweets
Dec 15, 2022
I gave a talk on inpatient bowel regimens today for the @YaleMed @YaleIMed residents and students, with additional 💎s on outpatient #constipation. Here are the slides!

💩 💩 💩

#MedTwitter #GITwitter #motility #MedEd @YaleIM_Chiefs @MayoClinicGIHep
Most inpatients require a bowel regimen. Our patients typically have most of the risk factors for #constipation!
#Constipation is more about symptoms than frequency! 🚽

It’s also a *symptom* (like chest pain), so need to figure out what’s causing it and treat accordingly.
Read 20 tweets
Dec 13, 2022
💨The gut microbiota generates ~0.2L–1.5L of gas per day
💨>99%: hydrogen (H2), carbon dioxide (CO2), & methane (CH4)– *odorless*
💨foul smell of gas from <1%: sulfur–containing gases hydrogen sulfide (H2S), methanethiol (CH3SH), dimethyl sulfide [(CH3)2S] + volatile compounds
🦠bacteria in the colon ferment substrates that are not digested or absorbed in the upper GI tract (e.g. carbohydrates, proteins, fats)
🦠produce short-chain fatty acids, branched-chain fatty acids, ammonia, N-nitro compounds, phenolic and indolic compounds, and various gases
Read 15 tweets
Oct 23, 2022
Summarizing our learning at #ACG2022 today! 🧑‍🎓

@tinahamd @AmCollegeGastro #MedTwitter #GITwitter
💎 GI bleeding🩸
💎#IBD
Read 8 tweets
Oct 23, 2022
Management of benign anorectal disorders with #AdilBharucha

#MedTwitter #GITwitter #ACG2022 Image
🔑Have patient complete symptom questionnaire to get a more detailed picture of their symptoms Image
🔑Digital rectal examination Image
Read 17 tweets
Oct 23, 2022
Chronic constipation is common and has tremendous impact on quality of life
#Constipation is NOT all about frequency. Ask about 👇
Read 20 tweets

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