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Published on: November 17, 2018
Patient-Reported Outcomes Correlate With Microbial Community Composition Independent of Mucosal Inflammation in
Jennifer Hellmann1,2, Allison Ta1,2, Nicholas J Ollberding2,3
1Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Fecal microbiota composition is linked to symptoms in pediatric inflammatory bowel diseases (IBD). Specific bacteria and metabolic pathways correlate with patient-reported outcomes (PROs) in Crohn's disease (CD) and ulcerative colitis (UC), suggesting a role beyond inflammation.
Area of Science:
- Gastroenterology
- Microbiome Research
- Pediatric IBD
Background:
- Inflammatory bowel diseases (IBD) result from abnormal host responses to gut microbes, causing inflammation and digestive issues.
- Patient-reported outcomes (PROs) are vital for assessing IBD impact and guiding research.
- Understanding the gut microbiome's role in pediatric IBD symptoms is crucial.
Purpose of the Study:
- To investigate the relationship between fecal microbiota and PROs in children and adolescents (0-22 years) with IBD.
- To identify specific microbial species and metabolic pathways associated with symptoms in Crohn's disease (CD) and ulcerative colitis (UC).
Main Methods:
- A prospective, single-center study analyzed shotgun metagenomics data from stool samples of pediatric IBD patients.
- Associations between microbial composition and PROs (stool frequency, rectal bleeding, abdominal pain) were examined.
- Negative binomial mixed-effects models controlled for clinical factors and fecal calprotectin levels.
Main Results:
- In CD, abdominal pain correlated with increased Haemophilus and decreased Clostridium species.
- In UC, rectal bleeding and increased stool frequency were linked to increased Klebsiella and decreased Bacteroides species.
- Symptomatic patients in both groups showed reduced microbial community stability; UC patients with symptoms had altered metabolic pathways.
Conclusions:
- Gut microbial composition is associated with patient-reported symptoms in pediatric IBD.
- Specific bacterial taxa and metabolic pathways correlate with symptoms in UC and CD.
- Microbiota may directly contribute to IBD symptoms, independent of mucosal inflammation severity.
Background:
Inflammatory bowel diseases (IBDs) involve an aberrant host response to intestinal microbiota causing mucosal inflammation and gastrointestinal symptoms. Patient-reported outcomes (PROs) are increasingly important in clinical care and research. Our aim was to examine associations between PROs and fecal microbiota in patients 0 to 22 years of age with IBD.
Methods:
A longitudinal, prospective, single-center study tested for associations between microbial community composition via shotgun metagenomics and PROs including stool frequency and rectal bleeding in ulcerative colitis (UC) and abdominal pain and stool frequency in Crohn's disease (CD). Mucosal inflammation was assessed with fecal calprotectin. A negative binomial mixed-effects model including clinical characteristics and fecal calprotectin tested for differentially abundant species and metabolic pathways by PROs.
Results:
In 70 CD patients with 244 stool samples, abdominal pain correlated with increased relative abundance of Haemophilus and reduced Clostridium spp. There were no differences relative to calprotectin level. In 23 UC patients with 76 samples, both rectal bleeding and increased stool frequency correlated with increased Klebsiella and reduced Bacteroides spp. Conversely, UC patients with lower calprotectin had reduced Klebsiella. Both UC and CD patients with active symptoms exhibited less longitudinal microbial community stability. No differences in metabolic pathways were observed in CD. Increased sulfoglycolysis and ornithine biosynthesis correlated with symptomatic UC.
Conclusions:
Microbial community composition correlated with PROs in both CD and UC. Metabolic pathways differed relative to PROs in UC, but not CD. Data suggest that microbiota may contribute to patient symptoms in IBD, in addition to effects of mucosal inflammation.
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