Crohn’s disease: microbiome changes after ileal resection

  • Sokol H & al.
  • Gut
  • 29 May 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • No fecal microbiome analysis. 
  • Validation required.

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