The International Journal of Gastroenterology and Hepatology Diseases - Volume 3, Issue 1, 2024

Herbal medications hold a dominant position in the pharmaceutical sector due to their well-established therapeutic effects and extremely low negative effects. Besides, herbal remedies are easily available and highly economical. However, to circumvent the issue of poor bioavailability, the combinatorial strategy of incorporating herbal medicines and nanotechnology is useful. The phytoconstituents molded in novel nanocarriers such as polymeric nanoparticles, polymeric micelles, liposomes, solid lipid nanoparticles, nanostructured lipid carriers, nanoemulsions, gold nanoparticles, etc., have been extensively investigated as they are the most promising approach for colon-targeting drug delivery systems. Although plant-based medicines have been developed for decades, there is enormous research interest in the development of an effective plant-derived delivery system for the incorporation of phytoconstituents into various nanomaterials to overcome potential challenges related to solubility, bioavailability, and stability issues. The encapsulation of phytoconstituents in a novel nanocarrier is a promising approach to improving the bioavailability, stability, and therapeutic efficacy of herbal medicines. The herbal nanomedicines are used as a promising tool for targeted delivery to the colon, with potentially effective outcomes for the treatment of colonic diseases, viz., ulcerative colitis, diverticulitis, Crohn's disease, shigellosis, constipation, colonic polyps, colon cancer, etc. This article presents a comprehensive survey of recent findings and patents by innovators working exclusively on nanoparticles for the delivery of phytomedicines for colon targeting.

The gut microbiota plays a key role in human health. Dominated by the phyla Firmicutes and Bacteroidetes, its composition is highly individualized and influenced by diet, age, genetics, and the environment. The gut-liver axis highlights the bidirectional relationship between the gut and the liver, impacting metabolic homeostasis and immune regulation. Gut dysbiosis, an imbalance in the gut microflora, contributes to liver diseases by disrupting gut barrier function and bile acid metabolism, leading to inflammation and fibrogenesis. Advancements in omics approaches, such as metagenomics, metatranscriptomics, metaproteomics, and metabolomics, have enhanced our understanding of the gut microbiota. These approaches offer insights into microbial composition and function, although they vary in cost, efficiency, and complexity. Metagenomics is widely used for its cost-effectiveness and rapid turnaround time despite limitations in taxonomic resolution, while metatranscriptomics, metaproteomics, and metabolomics offer functional and metabolic insights but require sophisticated techniques and expertise. The Firmicutes/Bacteroidetes (F/B) ratio is a potential biomarker of gut dysbiosis linked to obesity, type 2 diabetes mellitus, and liver diseases. However, its diagnostic reliability is debated due to variations in individual factors and a lack of data on its associations with several diseases. Future research should focus on integrating multi-omics approaches so as to provide a holistic view of the gut microbiota and its role in health and disease, aiming for applications in precision medicine. While promising, the F/B ratio should be used cautiously alongside other diagnostic measures. In addition, renewed efforts are needed to develop cost-effective and rapid analysis methods for clinical use.

Metabolic-dysfunction-associated steatotic liver disease (MASLD), previously referred to as nonalcoholic fatty liver disease (NAFLD), affecting approximately 30% of the global population. Projections suggest that MASLD incidence may rise by up to 56% over the next decade. MASLD has become the fastest-growing cause of hepatocellular carcinoma (HCC) in the USA, France, UK, and other regions worldwide. The prevalence of MASLD and MASLD-related liver damage is expected to parallel the increasing rates of obesity and type 2 Diabetes Mellitus (T2DM) globally. The factors contributing to MASLD development and its progression to metabolic-dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and HCC remain poorly understood. Evidence from cell-based, animal-based, and human-subject studies suggests that insulin resistance, endoplasmic reticulum stress, oxidative stress, impaired autophagy, genetics, epigenetics, reduced immune surveillance, increased gut inflammation, and gut dysbiosis are crucial events in MASLD pathogenesis. In recent years, dysregulation of gut microbiota has emerged as a potential mechanism implicated in MASLD and MASLD-related hepatocarcinogenesis. This review briefly outlines the mechanistic events significant for MASLD pathogenesis. Additionally, it offers insight into dysregulated gut microbiota and its correlation with MASLD and MASLD-related liver damage. Furthermore, it highlights pertinent questions for cell and microbiologists in the MASLD research field. It underscores the necessity for identifying factors leading to gut microbiome dysregulation in MASLD and MASH pathogenesis. Identifying these factors could aid in the development of novel strategies for managing MASLD and MASLD-related liver damage.

Colon cancer is a major global health concern characterized by complex interactions of genetic, environmental, and lifestyle factors. The “hallmarks of cancer” encompass various distinctions between cancerous and normal tissues, including vascular characteristics, making it a possible target for medication administration with specificity. The tumor microenvironment in colon cancer is a dynamic ecosystem comprising various cell types like cancer-associated fibroblasts, immune cells, and endothelial cells, influencing tumor progression and response to therapy. Various overexpressed receptors in colon cancer, like G-protein-coupled receptors (GPCRs), integrins, folate receptors, transferrin receptors, epidermal growth factor receptors (EGFRs), and CD-44 receptors, offer opportunities for targeted drug delivery. These receptors play vital roles in cancer cell growth, proliferation, and metastasis, making them important targets for therapeutic intervention.

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), formerly known as Non-alcoholic fatty liver disease (NAFLD), is characterized by fat accumulation in the liver and is associated with obesity, insulin resistance, and metabolic syndrome. Early detection and intervention are crucial to prevent disease progression to advanced fibrosis, cirrhosis, and liver failure. Non-invasive tests like transient elastography (TE), the Fibrosis-4 (FIB-4) index, the Enhanced Liver Fibrosis (ELF) score, and magnetic resonance imaging (MRI) are safer and more convenient than invasive procedures like liver biopsy for detecting advanced fibrosis in MAFLD patients. Agile 3+ is a non-invasive test that combines liver stiffness measurement (LSM) with clinical and laboratory findings to detect advanced fibrosis in MAFLD patients. It has shown high accuracy in detecting advanced fibrosis in MAFLD patients. The combination of LSM and laboratory findings provides a more accurate assessment of disease severity, making Agile 3+ a reliable, non-invasive test for assessing liver fibrosis in MAFLD patients. In summary, MAFLD is a common condition that can progress to advanced fibrosis and liver failure if left untreated. Non-invasive tests such as Agile 3+ have emerged as valuable tools for detecting advanced fibrosis in MAFLD patients, providing a more accurate assessment of disease severity and making it a reliable non-invasive test for assessing liver fibrosis in MAFLD patients

Gastrointestinal (GI) disorders encompassing conditions such as gastritis, peptic ulcers, and inflammatory bowel disorders are major global health concerns affecting millions worldwide. Conventional treatment options often come with undesirable side effects, prompting the search for alternative therapies. The herb's influence on digestive processes, mucosal protection, and modulation of gut microbiota shed light on maintaining potential GI health. Swertia chirayita (Gentianaceae), commonly known as 'Chirata', is a traditional medicinal herb that has been used for centuries in various cultures for its therapeutic benefits, particularly for GI ailments. Furthermore, this review highlights several scientific studies and clinical trials that support the traditional uses of Swertia chirayita in treating GI disorders. In conclusion, Swertia chirayit could be beneficial as a natural remedy with promising therapeutic potential for managing GI disorders. However, there are still some scientific gaps, such as the identification of bioactive compounds, the structure-activity relationship, the mechanistic action of isolated bioactive compounds, the development of effective analytical methods for comprehensive quality control, and safety profiles, that need to be addressed. Understanding its molecular mechanisms and conducting further clinical trials will contribute to establishing Swertia chirayita as a valuable addition to the armamentarium of natural therapies for GI health.

Hepatic encephalopathy is a neurological condition that affects people who have an insufficient liver function. However, its pathophysiology is yet unclear. For hepatic encephalopathy, pharmacotherapy is the primary treatment choice. Lowering ammonia levels, enhancing neurotransmitter signal transduction, and modifying gut microbiota, tackles the pathophysiology of hepatic encephalopathy. The intestinal microbiota of liver disease patients differs greatly from that of healthy people, and this difference is linked to the development of hepatic encephalopathy. Additionally, gut microbiota is intimately linked to several theories in the pathophysiology of hepatic encephalopathy, such as the GABA-ergic tone hypothesis, bile acid circulation, ammonia poisoning theory, and neuroinflammation, all of which exacerbate patients' cognitive and motor impairments. Providing some probiotics or reestablishing the intestinal bacteria's balance has a substantial impact on neurological illnesses in hepatic encephalopathy. The goal of this review is to determine the possible metabolic impacts and microbiological pathways in the gut-brain axis mediated progression of hepatic encephalopathy, as well as its potential function as a therapeutic target.

Campylobacteriosis is a foodborne disease caused by Campylobacter, which is one of the leading causative agents of bacterial gastrointestinal diseases in developed and developing countries. According to WHO, Campylobacter species infects a hundred million people yearly. The bacterium is thermotolerant, cytochrome oxidase-positive, spiral-shaped, gram-negative, and microaerophilic, by exhibiting corkscrew motility it passes through the intestines of animals and birds. It is generally transmitted through the consumption of contaminated food associated with animal and their products. The main infectious species include C. coli, C. jejuni, C. fetus and C. upsaliensis. Infection symptoms can be mild to serious depending upon the patient's age and in some cases can lead to permanent neurological disorders. Detection of Campylobacter in food, clinical and environmental samples is accomplished with the help of combinatorial usage of selective enrichment and culture methods. Currently, there is no sole viable approach for infection management because of resistance emergence. In this review article, we discuss Campylobacter epidemiology, pathogenicity, various diagnostic methods and treatment of Campylobacteriosis.

The gut is the most accommodating environment in the human body for bacteria. The microbial community there is both dense and varied. The gut microbe forms an axis with the human liver, according to the theory of liver disease causation. The portal vein, systemic circulation, and biliary tract all provide bidirectional connections between the liver and the intestines. The liver secretes bile acid and a wide variety of bioactive mediators into the biliary tract and general circulation.

On the other hand, the portal vein carries microbial-produced endogenous compounds from the colon to the liver, where they might disrupt liver function. Acetyl-aldehyde and butyrate are two of the many byproducts produced by the microbiota in the human gut in response to indigestible food. In addition, these two waste products alter liver function and play an important role in maintaining intestinal health in humans. This paper reviews the literature on the link between butyrate and acetyl-aldehyde production in the human gut and the organ's role in the development of liver disease. Butyrate, acetyl-aldehyde, and liver disease all play roles in the gut-liver axis.