Human intestinal spirochetosis, irritable bowel syndrome, and colonic polyps: A systematic review and meta‐analysis

Abstract

Human colonic spirochetosis (CS) is usually due toBrachyspira pilosicolior Brachyspira aalborgiinfection. While traditionally considered to be commensal bacteria, there are scattered case reports and case series of gastrointestinal (GI) symptoms in CS and reports of colonic polyps with adherent spirochetes. We performed a systematic review and meta‐analysis investigating the association between CS and GI symptoms and conditions including the irritable bowel syndrome (IBS) and colonic polyps. Following PRISMA 2020 guidelines, a systematic search of Medline, CINAHL, EMBASE, and Web of Science was performed using specific keywords for CS and GI disease. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random‐effects model. Of 75 studies identified in the search, 8 case–control studies met the inclusion criteria for meta‐analysis and 67 case series studies met the inclusion criteria for pooled prevalence analysis. CS was significantly associated with diarrhea (n = 141/127, cases/controls, OR: 4.19, 95% CI: 1.72–10.21, P = 0.002) and abdominal pain (n = 64/65, OR: 3.66, 95% CI: 1.43–9.35, P = 0.007). CS cases were significantly more likely to have Rome III‐diagnosed IBS (n = 79/48, OR: 3.84, 95% CI: 1.44–10.20, P = 0.007), but not colonic polyps (n = 127/843, OR: 8.78, 95% CI: 0.75–103.36, P = 0.084). In conclusion, we found evidence of associations between CS and both diarrhea and IBS, but not colonic polyps. CS is likely underestimated due to suboptimal diagnostic methods and may be an overlooked risk factor for a subset of IBS patients with diarrhea.

Anal cytology: Diagnosis of intestinal spirochaetosis

“…Intestinal spirochaetosis can affect any part of the colon. While some authors report it more frequent in the rectum, 5 where it was first described, more recent studies show a right colon preponderance 4,6 even with a rectum sparing pattern 7 . Besides, it has been demonstrated to affect the colon in a patchy discontinuous manner 8 .…”

“…Intestinal spirochaetosis is not a frequent diagnosis in daily clinical practice and it might be easily overlooked because of its resemblance to intestinal epithelial glycocalyx and the absence of an inflammatory reaction. Warthin‐Starry silver staining and Treponema pallidum immunohistochemistry can be helpful to highlight Brachyspira spirochaetes, 4 the latter due to antigen cross‐reactivity between spirochaetes genera. Intestinal spirochaetosis can affect any part of the colon.…”

“…It has also been linked with different colonic disorders such as polyps, inflammatory bowel disease, or diverticulosis. 4…”

“…It is a rare condition in Western countries and it usually affects HIV‐infected patients, 3 mainly men who have sex with men. It has also been linked with different colonic disorders such as polyps, inflammatory bowel disease, or diverticulosis 4 …”

Increased Prevalence of Symptomatic Human Intestinal Spirochetosis in MSM with High-Risk Sexual Behavior in a Cohort of 165 Individuals

“…Human intestinal spirochetosis (HIS) is defined as the colonization of the luminal surface of colonic and appendiceal epithelial cells by anaerobic spirochetes from the genus Brachyspira [ 1 , 2 , 3 ]. Of the nine identified Brachyspira species, only B. aalborgi and B. pilosicoli are known to colonize humans [ 4 , 5 , 6 , 7 ].…”