Digestion is extraordinarily complex, and there is a long list of ways it can go wrong. From constipation to bloating, digestive disorders can cause significant distress for infants and children as they develop. Fortunately, with emerging research on the microbiota, doctors, dietitians, and other healthcare professionals have a growing list of science-based strategies to use in addressing these problems.
Healthcare providers are challenged to navigate through gastrointestinal (GI) disorders using strategies backed by evidence, and also to prevent GI health problems from arising in the first place. Two guides, published this year in the Wiley Essential Knowledge Briefings series, tackle these issues.
A guide called Gut Health in Early Life: Significance of the Gut Microbiota and Nutrition for Development and Future Health gives an overview of the role that the gut microbiota play in maintaining digestive health through infancy and childhood. Another guide, called Gut Health in Early Life: Implications and Management of Gastrointestinal Disorders summarizes management of GI disorders in pregnant mothers and in young children.
Edited by a team of scientists and doctors, the guides are designed to get healthcare professionals on the same page in two areas of rapidly-evolving research: GI health and GI disease. Clear and readable, they are also suitable for patients to bring to their appointments as a starting place for discussion.
The first guide explains what we know about the gut microbiota and how they are a key factor in long-term health. The species of bacteria matter less than what those species do in a healthy gut, say the authors. A central idea is that diet – for example, breastfeeding in the early months of an infant’s life – is a ‘programming system’ that lays the foundation for future health.
The guide lays out something simple and surprising in its first figure: what it means to have a ‘healthy’ GI tract. Gut health is broken down into five aspects: not only the absence of GI illness, but also good digestion and absorption of nutrients, normal and stable gut microbiota, effective immune function, and – because of the gut’s known connections to the brain – a sense of wellbeing.
The emphasis in this guide is on prevention – that is, finding the beneficial functions of the gut microbiota and finding strategies that allow them to continue carrying out these functions. The microbiota must be prevented from falling into a state of ‘dysbiosis‘, in which the community of microorganisms is disturbed or imbalanced, say the authors. What is not mentioned is that dysbiosis is a slippery concept in the scientific world; everyone starts with a slightly different set of microorganisms, and even if you know exactly which ones are present in your gut, it’s nearly impossible to say at this stage whether it qualifies as normal or dysbiotic. Regardless of what dysbiosis means, however, scientists can focus on interventions that make things better. To this end, authors describe the level of evidence supporting the benefits of probiotics and prebiotics, as well as two other types of interventions: symbiotics (a combination of probiotics and prebiotics) and postbiotics (products of fermentation that contain no live bacteria).
The second guide, on GI disorders – including sections on maternal GI health surrounding pregnancy, as well as digestive problems and functional GI disorders in infants and young children – is a scientific summary of these topics that incorporates the newest microbiota research. The document’s clinical orientation is clear, as it includes algorithms and lists of pharmacological and non-pharmacological ways to manage each disease.
Functional gastrointestinal disorders (FGIDs), in which symptoms are not readily explained by physiological problems, are given well-deserved attention in this guide. Conditions like infantile colic, diarrhea and regurgitation are FGIDs that can cause much suffering and stress. Authors note that dysbiosis is being linked with several of these FGIDs, but scientists are still working out the details; meanwhile, microbiota research has yet to revolutionize treatment for these disorders.
Healthcare professionals are in a unique position to help the public understand the role that the microbiota play in health so that babies born in future can enjoy a long, healthy life. Only when these communities of microorganisms stop being ‘invisible’ will progress be made. These guides are a tool for this important ongoing education.