Environmental enteric dysfunction (EED) refers to a subclinical disorder of intestinal function common in tropical countries and in settings of poverty and economic disadvantage. The enteropathy that underlies this syndrome is characterized by mucosal inflammation and villus blunting mediated by T cell activation. Epithelial cell disruption and microbial translocation drive systemic inflammation. EED in young children is associated geographically with growth failure, malnutrition, and greatly impaired responses to oral vaccines, notably rotavirus and poliovirus vaccines. In this review, we describe the pathophysiology of EED and examine the evidence linking EED and oral vaccine failure. This evidence is far from conclusive. Although our understanding of EED is still sketchy, there is limited evidence of disturbed innate immunity, B cell disturbances including aggregation into lymphoid follicles, and autoantibody generation. Pathways of T cell activation and the possibility of dendritic cell anergy, which could help explain oral vaccine failure, require further work.

中文翻译：

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环境肠功能障碍的病理生理学及其对口服疫苗功效的影响。

环境性肠功能障碍 (EED) 是指在热带国家以及贫困和经济劣势环境中常见的亚临床肠道功能障碍。构成该综合征基础的肠病的特征是粘膜炎症和由 T 细胞活化介导的绒毛变钝。上皮细胞破坏和微生物易位驱动全身炎症。幼儿的 EED 在地理上与生长障碍、营养不良和对口服疫苗（尤其是轮状病毒和脊髓灰质炎病毒疫苗）的反应严重受损有关。在这篇综述中，我们描述了 EED 的病理生理学，并检查了 EED 与口服疫苗失败之间关联的证据。这个证据远非决定性的。尽管我们对 EED 的了解仍然很粗略，但先天免疫力受到干扰的证据有限，B 细胞紊乱，包括聚集到淋巴滤泡和自身抗体的产生。T 细胞活化途径和树突状细胞无反应性的可能性有助于解释口服疫苗的失败，需要进一步研究。