Cited by 1,081Gastrointestinal motility and disordersGut microbiota and healthInflammatory Bowel Disease

Leaky gut: mechanisms, measurement and clinical implications in humans

Open access
Camilleri, Michael·2019·Gut

Abstract

The objectives of this review on 'leaky gut' for clinicians are to discuss the components of the intestinal barrier, the diverse measurements of intestinal permeability, their perturbation in non-inflammatory 'stressed states' and the impact of treatment with dietary factors. Information on 'healthy' or 'leaky' gut in the public domain requires confirmation before endorsing dietary exclusions, replacement with non-irritating foods (such as fermented foods) or use of supplements to repair the damage. The intestinal barrier includes surface mucus, epithelial layer and immune defences. Epithelial permeability results from increased paracellular transport, apoptosis or transcellular permeability. Barrier function can be tested in vivo using orally administered probe molecules or in vitro using mucosal biopsies from humans, exposing the colonic mucosa from rats or mice or cell layers to extracts of colonic mucosa or stool from human patients. Assessment of intestinal barrier requires measurements beyond the epithelial layer. 'Stress' disorders such as endurance exercise, non-steroidal anti-inflammatory drugs administration, pregnancy and surfactants (such as bile acids and dietary factors such as emulsifiers) increase permeability. Dietary factors can reverse intestinal leakiness and mucosal damage in the 'stress' disorders. Whereas inflammatory or ulcerating intestinal diseases result in leaky gut, no such disease can be cured by simply normalising intestinal barrier function. It is still unproven that restoring barrier function can ameliorate clinical manifestations in GI or systemic diseases. Clinicians should be aware of the potential of barrier dysfunction in GI diseases and of the barrier as a target for future therapy.

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Crossref · 10.1136/gutjnl-2019-318427

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  • Dietary habits and a healthy lifestyle are of the foremost importance in maintaining healthy intestinal barrier functions.

    “Last, but definitely not the least, dietary habits and a healthy lifestyle are of the foremost importance in maintaining healthy intestinal barrier functions.207”

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  1. [89]Katzka DA, Geno DM, Blair HE, Small intestinal permeability in patients with eosinophilic oesophagitis during active phase and remission. Gut 2015; 64: 538– 43. 24957264
  2. [90]Warners MJ, Vlieg-Boerstra BJ, Verheij J, Esophageal and small intestinal mucosal integrity in eosinophilic esophagitis and response to an elemental diet. Am J Gastroenterol 2017; 112: 1061– 71. 28417991 PMC5527277

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Authors
Camilleri, M.
Affiliations
Mayo Clinic (US)
Corresponding author
Camilleri, Michael
Venue
Gut
Publisher
BMJ
Published
2019-05-10
Volume
68
Issue
8
Pages
1516-1526
ISSN
  • 0017-5749 (ISSN-L)
  • 1468-3288
OpenAlex
W2944348781
Cited by
1,081
References
136
Citations by year
2026: 159 · 2025: 193 · 2024: 178 · 2023: 175 · 2022: 169 · 2021: 124 · 2020: 69 · 2019: 14
FWCI
17.13
Type
journal article
Language
en
Open access
Locations
  • Gut (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
Keywords
leaky gut, intestinal barrier, intestinal permeability, epithelial permeability, mucus layer, paracellular transport, transcellular permeability, epithelial apoptosis, colonic mucosa, stress disorders, endurance exercise, nonsteroidal anti-inflammatory drugs, pregnancy, bile acids, food emulsifiers, fermented foods, dietary supplementation, inflammatory bowel disease, ulcerative colitis, intestinal barrier dysfunction
MeSH terms
Gastrointestinal Diseases, Humans, Intestinal Mucosa, Permeability, Disease Management

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