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!
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
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
Thank you so much to @DrPraegers for having me to discuss the effects of plant-based diets on the #gut#microbiome! Here are my slides for all to see! 😃
Defecation requires 1. intact #GI tract 2. coordination of many systems: neural (enteric nervous system, modulated by the peripheral somatic, autonomic and the CNS); muscular (smooth and striated); hormonal (endocrine and paracrine); and cognitive (behavioural and psychosocial)
🧑⚕️-😷
Doctor-patient communication
🧑⚕️A strong 🧑⚕️-😷 relationship is fundamental to the management of #IBS
😷Patients want their 🧑⚕️ to ⬆️empathy, support and information about the nature of IBS, diagnosis, and treatment options
DIAGNOSIS
🩸New pt: CBC, CRP or ESR, celiac serology and, if <45 w diarrhea, fecal calprotectin
➕Make POSITIVE diagnosis based on @RomeFoundation criteria
➡️Refer to #GI when: diagnostic doubt, pt w symptoms that are severe or refractory to 1stline tx,or when pt wants specialist
A little late but better late than never! ⌚️ Here's a recap of @AmCollegeGastro Virtual Grand Rounds by @ScottGabbardMD on...... FUNCTIONAL DYSPEPSIA!
🤢🤢🤢
This is a VERY common entity that is underdiagnosed! #MedTwitter take notice!
DYSPEPSIA = epigastric #pain. (can be associated with any other upper #GI symptom such as epigastric fullness, nausea, vomiting, or heartburn).
Dyspepsia is COMMON, and most cases are FUNCTIONAL (i.e., caused by brain-gut axis dysfunction)!
Like all disorders of gut-brain interactions FD pathophysiology is❌completely understood, but is thought to be complex+multifactorial. Components include
🤢disrupted duodenal barrier
🤢altered duodenal #microbiome
🤢dysmotility
🤢visceral hypersensitivity
🤢psychosocial stress