Clinical Review State of the Art Review

The role of the microbiome in human health and disease: an introduction for clinicians

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j831 (Published 15 March 2017) Cite this as: BMJ 2017;356:j831

Re: The role of the microbiome in human health and disease: an introduction for clinicians : Relative abundances of Gammaproteobacteria and relative paucity of anerobic bacteria precede Necrotising Enterocolitis in low birth weight baby

Necrotising enterocolitis is a catastrophic necro inflammatory injury to the intestine in low birth weight infants (5-10% of very low birth weight babies) through out the age of 2 months-9 months, and their mortality rate is about 25% and present treatment is bowel resections. Necrotising enterocolitis is associated positively with various antibiotics and found negatively with human milk and very costly probiotics. DNA analysis of stool culture in study of gut microbes shows commonly organisms such as Gram negative bacilli, Actinobacteria, and firmicutis, Propionibacteria, Bifidobacteria, and bacteriods are preventives of necrotising enterocolitis when overproduction of Gram negative facultative baccili and potentially pathogenic organisms such as E coli Enterobacter, Klebsiella and other obligate anaerobic bacteria particularly clostridia develops in the infant guts before necrotising enterocolitis and results in dysbiosis and ultimately necrotising enterocolitis.

The question is whether these Gram negative bacteria are associated with necrotising enterocolitis and result from dysbiosis. These Gram negative bacteria elicit mucosal injury to the bowel that resembles necrotising enterocolitis and we find that antibiotics can, however, diminish mucosal injury. TLR 4 which binds with bacterial lipopolysaccharides is implicated in cellular processes that actually underlie the cause of necrotising enterocolitis.

Anaerobic bacteria responding to microbiota-accessible carbohydrates produce short chain fatty acids, especially acetate, propionate and butyrate, which are anti-inflammatory too. Oral aminoglycosides which reduce populations of Gram negative gut bacteria but do not inhibit anaerobic bacteria may thus protect against necrotising enterocolitis though it is said that antibiotics use is a risk factor for necrotising enterocolitis and associated with lower proportion of protective anaerobes and lower proportion of Gamma proteobacteria.

Necrotising enterocolitis may be related to a lack of gut bacterial diversity.

So the question is, can probiotics with Bifidobacterium breve prevent necrotising enterocolitis?

Competing interests: No competing interests

12 April 2017
Professor Pranab Kumar Bhattacharya MD(calcutta University) FIC path (India)
Professor of Pathology
Sumona Mukherjee MD( Pathology), Associate Professor of Pathology CSTM kolkata -73 W.B, India; Upasana Bhattacharya; Rupak Bhattacharya; Ritwick Bhattacharya; Rupsa Bhattacharya; Dalia Mukherjee ; Ayeishi Mukherjee ;Oaindrila mukherjee; Debasisa Mukherjee; Hindole Banerjee of Residence 7/51 Purbapali; PO-Sodepur; 24 parganas (North) ;Kolkata-110 West Bengal; India and Rnna Mitra Social worker BK Mitra palliative care Barrackpore 24 parganas(North) West Bengal India
Murshidabad Medical College , West Bengal India
Berhampore Station Road, Berhampore Court, Murshidabad ,West Bengal, India