- After ileal resection for patients with Crohn’s disease (CD), the microbiota of the ileal mucosa changes dramatically.
- Recurrence is associated with microbiota at times of surgery that resembles active ileal CD.
- Nonrecurrence is associated with microbiota that resembles healthy people.
- Gut microbiota may be a good CD treatment target.
Why this matters
- Recurrence after this procedure is frequent.
- Current standard is ileocolonoscopy months later to look for endoscopic recurrence, but delay may mean missed opportunities for prevention.
- Predictors include male sex, active smoking at surgery, previous resection.
- Among patients with recurrence, microbiota changes included:
- Decreased alpha diversity,
- Increased Proteobacteria, and
- Decreased Firmicutes.
- In exploratory analysis, some characteristics of the gut microbiota at the time of surgery appeared to predict recurrence.
- Analysis of prospective multicenter cohort study (n=201, with 288 microbiota samples).
- Authors compared ileal mucosa-associated microbiota at time of surgery vs at endoscopic evaluation.
- Outcome: postoperative endoscopic recurrence.
- Funding: MSD France, Association François Aupetit, Helmsley Charitable Trust, Inserm.
- No fecal microbiome analysis.
- Validation required.