Exclusive enteral nutrition remodels the intestinal flora in patients with active Crohn's disease

Abstract

Background Although there are many hypotheses, the pathogenesis of Crohn's disease (CD) is not completely clear so far. Exclusive enteral nutrition (EEN) is a routine measure in the treatment of active CD. We aimed at investigating the impact of EEN on patients with active CD from microbial metabolomics. Methods 16S-rDNA sequencing technology and gas chromatography–mass spectrometer analysis were employed to investigate the modification of the intestinal flora and fecal short-chain fatty acid (SCFA) during the EEN. Results Seven patients with CD, who conducted EEN, were followed up successfully in the present study. The 8-week EEN resulted in a remission of the condition of subjects with active CD, as revealed by a significant decrease in erythrocyte sedimentation rate (ESR) (P = 0.018), C-reactive protein (CRP) (P = 0.028), and Crohn’s disease activity index (CDAI) (P = 0.018). The nutrition of the subjects was improved after an 8-week treatment course with EEN, which was associated with an increase in body mess index (BMI) (P = 0.018) and serum albumin (ALB) (P = 0.018) levels. Furthermore, our investigations revealed a significantly increased abundance of Firmicutes paralleled by decreased levels of Proteobacteria. With respect to the genus, five species of bacteria including Ruminococcus (P = 0.01), Lachnospiraceae (P = 0.02), Anaerotruncus (P = 0.04), Flavonifractor (P = 0.04), and Novosphingobium (P = 0.05) showed significantly increased abundance. This was accompanied by relative changes in fecal short-chain fatty acids levels. Moreover, we successfully constructed a stable model by combining these five significantly different genera to predict the therapeutic effect of EEN on patients with CD (AUC = 0.9598). Conclusions The findings indicated that EEN can alleviate the condition and the nutrition of patients with active CD by regulating the intestinal flora and influencing the expression level of fecal short-chain fatty acids.

The effects of pectin on the gut microbiota and serum metabolites in mice fed with a high fat diet and exposed to low-dose antibiotics

“…A recent clinical trial demonstrated that the amelioration effects of exclusive enteral nutrition against Crohn's disease were in positive correlations with the intestinal abundance of Novosphingobium. 48 However, in our study, both Novosphingobium and Stenotrophomonas which were significantly enriched in mice of the HFD_ABX and L102 groups, were positively related to the abundance of intestinal Lactobacillus but may contribute to the oxidative stress in the liver and the damage of the intestinal barrier. Klebsiella was obviously enriched in the mice of the HFD_ABX and NC_ABX groups, and both L102 pectin and L13 pectin were able to significantly reduce the relative abundance.…”

Causal Relationship between Physiological and Pathological Processes in the Brain and in the Gastrointestinal Tract: The Brain–Intestine Axis

“…Endoscopic indicators are considered the gold standard for measuring the activity of Crohn's disease; they are more often used in clinical trials to measure the effectiveness of various drugs with respect to induction and mainte- nance of mucosal healing. The most common assessment systems used to measure the clinical activity of the disease include the Crohn's Disease Activity Index (CDAI), the Harvey-Bradshaw Index (HBI) and the Short Questionnaire on Inflammatory Bowel Diseases (SIBDQ) [25][26][27][28][29]. The Crohn's Disease Activity Index is a research tool used to quantify the symptoms of Crohn's disease patients.…”

“…The Harvey-Bradshaw Index was developed in 1980 as a simpler version of CDAI for data-collection purposes. It consists only of clinical parameters: general well-being (0 = very good, 1 = slightly below aver- The Short Questionnaire of Inflammatory Bowel Diseases is a widely used tool for assessing the quality of life associated with health in patients with IBD [25][26][27][28][29]. Treatment of Crohn's disease is considered as a developing problem due to its widely heterogeneous manifestations, coincidence of characteristics with other inflammatory diseases, often elusive extraintestinal manifestations, and uncertain etiology.…”

“…One of the possible mechanisms of disorders is the presence of some specific antigen in the intestinal lumen/blood of patients, leading to the activation of T-lymphocytes and cellular macrophages, to the production of antibodies, cytokines, prostaglandins, and active forms of nitrogen and reactive oxygen species, which activate oxidative and nitrosative stress and cause the formation of nitrogen dioxide (NO 2 ) and OH radicals and peroxynitrite capable of causing various damage to cells and tissues [52][53][54]. Exclusive enteral nutrition is a common method in the treatment of the active stage of Crohn's disease [55,56].…”

“…This is because a researcher always outlines certain boundaries based on the purpose and objective of the study and then translates this complex reality into one or another scheme. Considering that publications on a causal relationship between the brain and the gastrointestinal tract were published in the most prestigious journals, for example, "Nature Review" [1,2], "Science" [9] and in other journals included in the first and second quartile [3][4][5][6][7][8][10][11][12], it seems necessary to analyze and summarize the data that appeared in the last decades of the 21st century [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”