implicating parasites or other infections as a cause of allergic
inlammation of the intestine.
Those who develop acute bacterial gastroenteritis, which
usually starts with sudden severe vomiting and diarrhoea, are
also at much higher risk of developing functional dyspepsia
long-term.
And inally, if you develop this allergic inlammation in the
upper intestine, the stomach fails to relax normally in some
cases. This may lead to the muscle around the lower end of the
oesophagus relaxing when it should not, allowing stomach acid
to move up and cause yet another common problem: acid relux.
A thrilling area in medical science at the moment is the real-
isation we are all only part-human: more than 100 trillion bugs
live in our mouth, intestines, skin and elsewhere, equating to
ten times the number of human cells in our body. These living
organisms are not passive passersby; they almost certainly do
things with us and to us, including preventing or causing disease
depending on the circumstances.
Our latest data indicate that the bacteria in the upper intes-
tine are different in people with functional dyspepsia, and we
are working to understand the implications. It may be that
disturbances in the bacteria in some cases alter intestinal inlam-
mation, and this leads to brain dysfunction and then anxiety or
depression. If so, manipulating these organisms or replacing
the bad bacteria with good ones may allow a return to health
for those with chronic gut and mental health problems. Animal
model experiments support these assumptions, but much more
work will be needed to devise the best approaches going forward.
Do you often feel full soon after eating most meals and can’t
inish a normal-sized meal? Or do you often feel really bloated
and uncomfortable after a meal, or suddenly develop pain or a
burning sensation in the pit of your stomach after eating? What
should you do if you think you or a loved one might have func-
tional dyspepsia because of these symptoms?
Asking your doctor to evaluate you is the sensible irst step
as there are other less common causes of these symptoms. And
if you do have functional dyspepsia, there is hope that new
treatments aimed at allergic inlammation in the upper intes-
tine may help to relieve the symptoms in the gut and perhaps
the brain. For example, the allergic gut inlammation may
respond to certain anti-asthma drugs that stop eosinophils
from causing harm. We are currently conducting a clinical trial
of a locally acting drug that dampens inlammation.
The stomach and bowel are easier to reach and manipulate
than the brain. Doing so looks likely to open the door to new
health possibilities for us all.
Nicholas Talley is Laureate Professor of Medicine at The University of Newcastle.APRIL 2016|| 29TTell us what you think
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“... we now have direct evidence
that changes in the upper intestine
near the stomach are likely to cause
brain symptoms such as anxiety and
possibly fatigue and sleep
disturbances.”