Clinical relevance of intestinal barrier dysfunction in common gastrointestinal diseases

Abstract

The intestinal barrier is a complex and well-controlled physiological construct designed to separate luminal contents from the bowel wall. In this review, we focus on the intestinal barrier’s relationship with the host’s immune system interaction and the external environment, specifically the microbiome. The bowel allows the host to obtain nutrients vital to survival while protecting itself from harmful pathogens, luminal antigens, or other pro-inflammatory factors. Control over barrier function and the luminal milieu is maintained at the biochemical, cellular, and immunological level. However, disruption to this highly regulated environment can cause disease. Recent advances to the field have progressed the mechanistic understanding of compromised intestinal barrier function in the context of gastrointestinal pathology. There are numerous examples where bowel barrier dysfunction and the resulting interaction between the microbiome and the immune system has disease-triggering consequences. The purpose of this review is to summarize the clinical relevance of intestinal barrier dysfunction in common gastrointestinal and related diseases. This may help highlight the importance of restoring barrier function as a therapeutic mechanism of action in gastrointestinal pathology.

Keywords: Intestinal barrier, Microbiome, Gastrointestinal disease, Inflammatory bowel disease, Inflammatory bowel syndrome, Colitis

Core Tip: Intestinal barrier dysfunction is an underlying pathophysiological feature in many gastrointestinal diseases. Understanding barrier dysfunction may help drive a deeper understanding of gastrointestinal pathology and identify novel way(s) to manage and/or treat disease. Here, we summarize the evidence supporting intestinal barrier dysfunction in common immune-mediated gastrointestinal diseases and its clinical relevance.