1. WORLD DIGESTIVE HEALTH DAY
29th May.
Bangladesh Gastroenterology Society creating awareness nation-wide.

2. Importance in health and disease
Slogan
Gut microbes-
Importance in health and disease

3. GUT FLORA AND HEALTH Dr. Jimma Hossain MBBS, MD (Gastro)
Assistant Professor
Department of Gastroenterology
Rangpur Medical College & Hospital

4. Gut flora Gut flora consists of a complex of microorganism species.
Human intestine carries about 100 trillion microorganisms.
Ten times greater than total cell in body.

5. Gut flora About 500 different species live in gut.
Bacteria makeup the majority.
Over 99% of bacteria are anaerobes.
Fungi, protozoa and archaea also part of gut flora,but little is known about their activities.

6. Gut flora
Most bacteria belong to genera Bacteroids,Clostridium,Fusobacterium,Eubacterium,Ruminococcus,Peptococcus,Peptostreptococcus and Bifidobacterium.
Bacteroids alone constitute 30%.
Fungi include Candida, Saccharomyces, Aspergillus and Penicillium.
Archea another large class of flora important for metabolism of bacterial products of fermentation.

7. Gut flora and diet
Association between concentration of microbial community and dietary components.
Prevotella with carbohydrate based diet.
Bacteroids with animal protein diet.
Gut flora can be changed by following a long term diet.

8. Acquisition of gut flora
At birth digestive tract is sterile.
Colonised by microbes within first few days.
All infants initially colonized by E.coli and Streptococci and subsequently anaerobes predominate.
Breast fed babies predominated by Bifidobacteria.
With introducton of other foods,a diverse microbial population develops.

9. Gut flora and health
Research suggests relationship between gut flora and humans not merely commensal ,but rather mutualistic.
Though people can survive without gut flora,microorganisms perform a host of useful functions.

10. Gut Flora
A healthy digestive system should contain at least 80-85% friendly bacteria to prevent diseases caused by organisms like E. coli & salmonella.
Stomach
10¹-10³ cfu/ml
Duodenum
10¹-10³ cfu/ml
Jejunum/Ileum
cfu/ml
Colon
10¹¹-10¹² cfu/ml

11. Useful Functions Recycle energy by fermenting unused energy substrate.
Early development & training of the immune system.
Prevention of the growth of harmful pathogenic bacteria.
Regulation of the development of gut.
Production of vitamins such as biotin, folate and vitamin K.

12. Useful Functions
Antidiabetic,anticarcinogenic,hypocholesterolemic role.
However,in certain conditions,some species capable of causing disease by producing infection,increasing cancer risk for the host.

13. Fermentation Saccharolytic - more favorable.
Proteolytic- less favorable.

14. Saccharolytic fermentation
Carbohydrates fermented into short chain fatty acids(SCFAs).
Acetic acid,propionic acid and butyric acid.
These are used by enterocytes and other cells and helps mineral absorption.
Butyric acid provides energy to gut cells and prevents cancer.

15. Potential Mechanisms of Anti-neoplastic Action
Angiogenesis
Inflammation
Immunosurveillance
Proliferation
Apoptosis
Butyrate

16. Proteolytic Fermentation
Breaks down proteins like enzymes,dead host and bacterial cells,collagen,elastin.
Can produce toxins and carcinogens in addition to SCFAs.

17. Trophic effects
SCFAs increase growth of intestinal epithelial cells and control proliferation and differentiation.
Growth of the lymphoid tissue near the gut.
Prevents cells from injury.
Prevents cancer.

18. Suppression of pathogenic microbial growth
Prevents harmful bacteria through competitive exclusion.
By competing for nutrition and attachment sites to epithelium.
Produce bacteriocins that kills harmful microbes.
By producing acids during fermentation lowers colonic PH and thus prevents proliferation of harmful species and facilitating helpful species.
By influencing mucosal barrier.
By influencing immune function.

20. Immunity Gut flora have regulatory effects on mucosal immune response.
Key in promoting early development of gut’s mucosal immune system.
Stimulate lymphoid tissue associated with the gut to produce antibodies to pathogens.

21. Modulation of immune response by flora
Immunity
Modulation of immune response by flora
Stimulation of mucosal immunity
* Better oral vaccine responses
* Control infections
Suppression of mucosal immunity
* Reduce allergy
* Reduce inflammation

22. Prevention of allergy
Can influence tolerance of gut immune system to antigens
Helpful gut flora stimulate immune system and train it to respond properly to antigens.
Lack of these bacteria in early life leads to an inadequately trained immune system that over reacts to antigens.

23. Prevention of allergy
Composition of gut flora varies in patients with/without allergies.
In allergy: Bacteroides, Bifidobacteria S.aureus, C.difficile

24. Prevention of inflammatory bowel disease
SCFAs prevent IBD.
Some form of bacteria can prevent inflammation.
Linked to good hygiene in youth.
Inversely linked with poor sanitation during first year of life.
Antibiotics that kill native bacteria.
High concentration probiotics decrease inflammation.

25. Alteration in flora balance
Inflammation
Antibiotic use
AAD
Irritating bowel directly
Changing levels of gut flora, alteration in flora balance.
Allowing pathogenic bacteria to grow
Decreased ability to ferment CHO and bile acids
Over growth of C.difficile
Gut flora composition also changes in severe illness, ischaemia, immune compromise.

26. Alteration in flora balance
Pharmabiotics
Generic term to encompass any form of therapeutic exploitation of commensal flora
Use of live probiotic bacteria,pre-biotics,synbiotics(genetically modified commensal).
Pre-biotics : dietary components that foster the growth of micro organisms in the gut
Pregnancy.
Wt loss.

27. Role in disease
Have pathogenic properties in addition to their health-inducing ones.
They can produce toxins and carcinogens.

28. Role in disease
Implicated in conditions as MOF,sepsis,colon cancer and IBD.
A major factor in health is the balance of bacterial numbers ; if too high or low,will harm the host.

29. Role in disease
Some genera-Bacteroids and Clostridium associated with in increase in tumor growth rate.
Lactobacillus and Bifidobacteria are known to prevent tumor formation.

30. Role in disease
Bacterial translocation in certain conditions causes sepsis.
Implicated in colitis, obesity.

31. Conclusion
The gastrointestinal tract is now considered one of the most complex microbial ecosystem on earth.
Till to date, little is known about this ecosystem.
Researches are going on to explore undiscovered aspects of gut flora in health & disease.