Colonic fermentation yields both gases (e.g., hydrogen, methane, and carbon dioxide) and short-chain fatty acids (SCFAs; e.g., acetic, propionic, and butyric acids), which exert several effects of major physiological and pathophysiological importance. The production and absorption of SCFAs facilitate the uptake of electrolytes and water and reduce the osmotic effect of unabsorbed carbohydrate molecules. Hence, diarrhea will ensue if colonic fermentation capacity is impaired (e.g., antibiotic-associated diarrhoea) or overwhelmed (e.g., lactase deficiency). Colonocytes rely mainly on nutrition from the colonic lumen (the “milieu extérieur”) and have a preference for using butyrate as an energy substrate. “Starvation colitis” may develop if access to SCFAs is hindered, and failure of β-oxidation of SCFAs has been proposed as a pathogenetic mechanism for ulcerative colitis. SCFAs, especially butyrate, display antineoplastic properties and may prevent the development of colorectal cancer. Furthermore, microbial fermentation products influence gastrointestinal motility and sensitivity and may play a role in the pathogenesis of irritable bowel syndrome.
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