Gut Microbiota Profiles and Microbial-Based Therapies in Post-operative Crohn's Disease: A Systematic Review

Abstract

Background and Aims: Gut microbiota recolonization after intestinal resection had been reported to be associated with post-operative recurrence in Crohn's disease (CD). However, the results of different studies are inconsistent and even contradictory. In addition, knowledge on the efficacy of microbial-based therapies in preventing post-operative recurrence of CD is limited. Therefore, the aim of this review was to investigate gut microbiota profiles in patients with CD before and after surgery and evaluate microbial-based therapies in preventing post-operative recurrence.Methods: Electronic databases were searched from inception to 31 June 2020 using predefined terms. Studies that investigated gut microbiota pre- and post-intestinal resection, and microbial-based therapies in preventing post-operative recurrence, were eligible. Study quality was assessed using either the Newcastle–Ottawa scale or Jadad scoring system.Results: Twelve studies investigating gut microbiota of CD patients suffering from operation, and other 12 studies evaluating the efficacy of antibiotics and probiotics, were included in our review. The mucosa-associated microbiota in surgical biopsy of CD patients is significantly distinct from that in normal mucosa from healthy subjects. Gut microbiota recolonization following surgery might be associated with post-operative recurrence in CD patients. Furthermore, CD patients with post-operative recurrence presented a gain in pro-inflammatory pathogenic bacteria and a loss in short-chain fatty acid-producing bacteria before and after surgery. However, no consistent bacteria or metabolites were found to predict the post-operative recurrence of CD. Additionally, microbial-based therapies are deficient and present restricted widespread clinical utility due to several deficiencies.Conclusion: Recurrence-associated bacteria observed pre- and post- operation might be promising in preventing the post-operative recurrence of CD. Furthermore, potential microbe biomarkers for predicting subsequent disease recurrence should be validated with larger sample sizes using more rigorous and standardized methodologies.

In-depth characterization of the serum antibody epitope repertoire in inflammatory bowel disease using phage-displayed immunoprecipitation sequencing

“…To what extent these lasting immune effects are captured, however, remains unknown. For instance, antimicrobial antibody responses in patients with a history of ileocecal resection corresponded well to typical shifts of bacterial populations that are known to occur following postoperative microbial recolonization in patients with CD (Machiels et al, 2020; Zhuang et al, 2021). Similarly, patients who underwent colon resections in the past showed decreased antibody responses against EBV, whose presence is associated with severe, refractory colitis and a higher colectomy requirement in patients with UC (Hosomi et al, 2018; Pezhouh et al, 2018).…”

Mucosal host–microbe interactions associate with clinical phenotypes in inflammatory bowel disease

“…Earlier studies had shown that Lachnoclostridium bacteria are generally increased in patients with (complicated) CD, e.g. postoperative CD [61], ASCA-positive CD [62] and active granulomatous colitis [63]. Recently, Lachnoclostridium was also associated with non-invasive diagnosis of colorectal adenoma and colorectal cancer [64, 65].…”

Endoscopic Recurrence or Anastomotic Wound Healing Phenomenon after Ileocolic Resection for Crohn’s Disease: The Challenges of Accurate Endoscopic Scoring

“…Lastly, there has been interest in the interaction of the gut microbiome after intestinal resection and postoperative recurrence.. 20–22 A recent systematic review failed to draw unambiguous conclusions after evaluating studies on gut microbiota profiles, postoperative recurrence and postoperative microbial-based therapies in CD patients. 23 Some studies reported that postoperative treatment with low-dose metronidazole resulted in decreased postoperative endoscopic recurrence. 24–26 It can be hypothesized that the inverted stapled anastomosis with an open wound and ischaemia provides an excellent entry point for the microbiome, which might interfere with, and potentially complicate, wound healing and gut immunity.…”