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The microbiome in adolescents with irritable bowel syndrome and changes with percutaneous electrical nerve field
Daniel F Castillo1,2, Lee A Denson1,2, David B Haslam3
1Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Pediatric irritable bowel syndrome (IBS) involves microbiome changes, particularly increased Firmicutes. Non-invasive nerve stimulation (PENFS) improved IBS symptoms and reduced specific microbial pathways, suggesting potential therapeutic targets.
Area of Science:
- Gastroenterology
- Microbiome Research
- Pediatric Health
Background:
- Irritable bowel syndrome (IBS) is a gut-brain axis disorder influenced by the gut microbiome.
- Pediatric IBS research, especially concerning centrally mediated treatments, is limited.
- This study investigates the microbiome in pediatric IBS patients and its relationship with symptoms and a novel treatment.
Purpose of the Study:
- To compare the gut microbiome composition between pediatric IBS patients and healthy controls.
- To assess the association between microbiome alterations and symptom severity in pediatric IBS.
- To evaluate the impact of percutaneous electrical nerve field stimulation (PENFS) on the microbiome and IBS symptoms.
Main Methods:
- Stool samples were collected from 27 pediatric IBS patients and 34 healthy controls (HC).
- Metagenomic sequencing analyzed microbial diversity, composition, and metabolic pathways (MetaCyc).
- A subset of IBS patients received 4 weeks of PENFS, with data collected pre-treatment, post-treatment, and at follow-up.
Main Results:
- Increased abundance of twelve species, including Firmicutes spp., and carbohydrate degradation/long-chain fatty acid (LCFA) synthesis pathways were observed in IBS patients.
- PENFS treatment led to significant improvements in pain, disability, and catastrophizing scores in female participants.
- Carbohydrate degradation and LCFA synthesis pathways decreased after PENFS treatment and at follow-up.
Conclusions:
- Elevated levels of Firmicutes and LCFA synthesis pathways in IBS patients suggest a role in pain potentiation.
- PENFS effectively improved abdominal pain, functioning, and catastrophizing in pediatric IBS patients.
- Decreased Clostridial species and LCFA pathways post-PENFS indicate potential therapeutic targets for centrally mediated IBS treatments.
Background:
Irritable bowel syndrome (IBS), a disorder of the gut-brain axis, is affected by the microbiome. Microbial studies in pediatric IBS, especially for centrally mediated treatments, are lacking. We compared the microbiome between pediatric IBS patients and healthy controls (HC), in relation to symptom severity, and with percutaneous electrical nerve field stimulation (PENFS), a non-invasive treatment targeting central pain pathways.
Methods:
We collected a stool sample, questionnaires and a 1-2 week stool and pain diary from 11 to 18 years patients with IBS. A patient subset completed 4 weeks of PENFS and repeated data collection immediately after and/or 3 months after treatment. Stool samples were collected from HC. Samples underwent metagenomic sequencing to evaluate diversity, composition, and abundance of species and MetaCyc pathways.
Key Results:
We included 27 cases (15.4 ± 2.5 year) and 34 HC (14.2 ± 2.9 year). Twelve species including Firmicutes spp., and carbohydrate degradation/long-chain fatty acid (LCFA) synthesis pathways, were increased in IBS but not statistically significantly associated with symptom severity. Seventeen participants (female) who completed PENFS showed improvements in pain (p = 0.012), disability (p = 0.007), and catastrophizing (p = 0.003). Carbohydrate degradation and LCFA synthesis pathways decreased post-treatment and at follow-up (FDR p-value <0.1).
Conclusions And Inferences:
Firmicutes, including Clostridiaceae spp., and LCFA synthesis pathways were increased in IBS patients suggesting pain-potentiating effects. PENFS led to marked improvements in abdominal pain, functioning, and catastrophizing, while Clostridial species and LCFA microbial pathways decreased with treatment, suggesting these as potential targets for IBS centrally mediated treatments.
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