Pr. Olivier Goulet : Gastrointestinal disorders in children, the need to act

What are the main childhood gastrointestinal disorders involving the microbiota?

I count five of them. The first two are infectious (or post-infectious) diseases related to an infestation by pathogens, and inflammatory bowel diseases, which are due to a conflict between the immune system and commensal bacteria. But intestinal microbiota is also involved in food allergies, functional disorders (irritable bowel syndrome, constipation), as well as in obesity. Whether intestinal dysbioses are the cause or the consequence of these diseases has yet to be determined. Any change in the microbiota is likely to lead to functional changes, or even organic alterations, and conversely. Simply put, we estimate that infections can generate a dysbiosis and that chronic inflammatory bowel diseases can cause, as well as be caused by, a dysbiosis. The mechanisms involved in allergies are quite unclear but they could develop even before the maturation of the immune system, while later and/or prolonged changes could be involved in gastrointestinal functional disorders or obesity..

Is France especially exposed to this type of disease?

These observations are unquestionable, but they are not specific to France. The incidence of diseases mentioned earlier has increased in the past 20 years and I believe it could be called an “epidemic”. What changed? The number of C-sections, antibiotic administration and antacids. Our dietary habits and the composition of the food we eat, especially in terms of preservatives, also play a role. All these elements are involved in the disruption of our intestinal microbiota. We should not draw simplistic conclusions, but we should bear in mind that a wide range of arguments and studies correlate these changes to a significant increase in certain childhood diseases. The challenge is even more critical in pediatrics since events that happen at birth or early childhood tend to have a lasting impact on the microbiota composition and longterm consequences on health.

How can we improve this situation and improve patient treatment?

Health professional believe that the emergency is to obtain an easier and less expensive access to intestinal microbiota metagenomics analysis methods. This could provide a qualitative comparison of the microbiota composition of the same individual at different times. Identifying changes between “baseline microbiota” and that observed during the course of a disease could help us identify pathophysiological mechanisms and develop personalized or targeted therapeutic responses. In this context, the probiotics approach seems to be effective in certain intestinal disorders and deserves to be further investigated. Some countries are starting to show interest in this topic, but France must not be left behind, especially within the European Union. Moreover, we should adopt a true “culture of prevention”, with the support from public authorities, that includes the protection of intestinal microbiota. This would contribute to limit exposure to risk factors that are likely to generate dysbioses (C-sections, antibiotics, antacids, inadequate diet, etc.) and would decrease the number of several childhood diseases.