BACKGROUND Environmental enteric dysfunction (EED) is an acquired enteropathy of the small intestine, characterized by enteric inflammation, villus blunting and decreased crypt-to-villus ratio. EED has been associated with poor outcomes, including chronic malnutrition (stunting), wasting and reduced vaccine efficacy among children living in low-resource settings. As a result, EED may be a valuable interventional target for programs aiming to reduce childhood morbidity in low and middle-income countries. MAIN TEXT Several highly plausible mechanisms link the proposed pathophysiology underlying EED to adverse outcomes, but causal attribution of these pathways has proved challenging. We provide an overview of recent studies evaluating the causes and consequences of EED. These include studies of the role of subclinical enteric infection as a primary cause of EED, and efforts to understand how EED-associated systemic inflammation and malabsorption may result in long-term morbidity. Finally, we outline recently completed and upcoming clinical trials that test novel interventions to prevent or treat this highly prevalent condition. CONCLUSIONS Significant strides have been made in linking environmental exposure to enteric pathogens and toxins with EED, and in understanding the multifactorial mechanisms underlying this complex condition. Further insights may come from several ongoing and upcoming interventional studies trialing a variety of novel management strategies.

中文翻译：

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环境肠道功能障碍：潜在机制，后果和管理策略的综述。

背景技术环境肠功能障碍（EED）是小肠的后天性肠病，其特征在于肠炎症，绒毛变钝和隐窝-绒毛比率降低。EED与不良预后相关，包括慢性营养不良（昏迷），消瘦和资源匮乏地区儿童的疫苗效力下降。因此，EED可能是旨在降低中低收入国家儿童发病率的计划的重要干预目标。正文几种高度合理的机制将EED潜在的病理生理机制与不良预后联系起来，但是这些途径的因果关系已被证明具有挑战性。我们提供了有关评估EED的原因和后果的最新研究的概述。这些研究包括对亚临床肠道感染作为EED的主要原因的作用进行研究，并努力了解EED相关的全身性炎症和吸收不良如何导致长期发病。最后，我们概述了最近完成和即将进行的临床试验，这些试验将测试新颖的干预措施以预防或治疗这种高度流行的疾病。结论在将环境暴露于肠病原体和毒素与EED联系起来，以及在理解这种复杂条件下的多因素机制方面取得了重大进展。进一步的洞察力可能来自对各种新颖的管理策略进行试验的正在进行的和即将进行的干预研究。我们概述了最近完成和即将进行的临床试验，这些试验将测试新颖的干预措施来预防或治疗这种高度流行的疾病。结论在将环境暴露于肠病原体和毒素与EED联系起来，以及在理解这种复杂条件下的多因素机制方面取得了重大进展。进一步的洞察力可能来自对各种新颖的管理策略进行试验的正在进行的和即将进行的干预研究。我们概述了最近完成和即将进行的临床试验，这些试验将测试新颖的干预措施来预防或治疗这种高度流行的疾病。结论在将环境暴露于肠病原体和毒素与EED联系起来，以及理解这一复杂条件的多因素机制方面已取得了重大进展。进一步的洞察力可能来自对各种新颖的管理策略进行试验的正在进行的和即将进行的干预研究。