Medically reviewed by Onikepe Adegbola, MD, PhD
Patients with inflammatory bowel disease (IBD) have dysbiosis in the gut even when they are in remission, reports a study entitled “Dysbiosis in the Gut Microbiota in Patients with Inflammatory Bowel Disease during Remission.”This study was recently published in Microbiology Spectrum.
This study was conducted on 98 patients with inactive IBD and 97 healthy controls in Malta, Europe. IBD patients in this study were either diagnosed with ulcerative colitis (66/98) or Crohn’s disease (32/98).
The authors reported that IBD patients in remission had fewer and less diverse healthy bacteria than controls. In contrast, they had higher flavonoid-degrading bacteria (Flavonifractor plautii and Eggerthella lenta). In addition, they also had higher enterobacteria (Escherichia, Shigella, Klebsiella, Enterobacter, and Citrobacter), which are some of the main triggers of gut inflammation.
The authors concluded that IBD patients in remission had a “high” degree of gut dysbiosis. This would greatly increase the vulnerability of patients with IBD, and they would be likely to fall into relapse with minor insults.
What are the Major Clinical Implications of This Study?
The study authors highlight that persistent gut dysbiosis in IBD patients with the inactive disease can have major clinical implications.
Alterations in the composition and functioning of gut microbes in IBD patients in remission could behave as triggers for maintaining the disease in a subdued fashion for long periods. They can also precipitate a relapse of the patient’s symptoms and may eventually require treatment changes to induce a fresh remission. Thus, the management of gut dysbiosis is vital in IBD patients with remission.
In addition, the higher distribution of flavonoid-degrading bacteria in patients with IBD in remission may open treatment opportunities through dietary flavonoid restriction. However, more research is required on this aspect.
What is the Key Scientific Message of This Study?
The authors reiterated that gut dysbiosis is accompanied by changes in the composition of not only gut microbes but also bacterial products and metabolites. These countless alterations can affect the immune system directly and indirectly in multiple ways. It is noteworthy that immune derangements are the hallmarks of patients with IBD. Gut dysbiosis remains one of the main contributors to the immune derangement of IBD.
What was the Definition of Inactive IBD in This Study?
In this study, inactive IBD was confirmed using fecal calprotectin values with or without normal endoscopy or bowel imaging over the last six months. Fecal calprotectin values below 250 𝞵g/g were considered a marker of inactive IBD in this study. In addition, the study participants did not use IBD medications, such as antibiotics, probiotics, bowel-cleansing medications, or systemic corticosteroids, for the 3 months before enrolling in this study.
Pisani, A., Rausch, P., Bang, C., Ellul, S., Tabone, T., Marantidis Cordina, C., Zahra, G., Franke, A., & Ellul, P. (2022). Dysbiosis in the Gut Microbiota in Patients with Inflammatory Bowel Disease during Remission. Microbiology spectrum, e0061622. Advance online publication. https://doi.org/10.1128/spectrum.00616-22