Colonic bacterial diversity and dysbiosis in active microscopic colitis as compared to chronic diarrhoea and healthy controls: effect of polyethylene glycol after bowel lavage for colonoscopy

Lissette Batista, Virginia Robles, Chaysavanh Manichanh, Laura Ruiz, Danila Guagnozzi, Ferran Pinsach, Francisco Guarner, Fernando Fernández-Bañares, Lissette Batista, Virginia Robles, Chaysavanh Manichanh, Laura Ruiz, Danila Guagnozzi, Ferran Pinsach, Francisco Guarner, Fernando Fernández-Bañares

Abstract

Background: Most microbiota studies in microscopic colitis patients are performed after diagnostic colonoscopy without considering the potential effect of colonic lavage. Patients may achieve clinical remission after colonoscopy and it is unknown whether lavage-induced changes play a role.

Aim: To assess the effect of polyethylene glycol (PEG) colonic lavage on clinical remission rate, microbial diversity, microbial dysbiosis index and specific microbial changes in patients with active microscopic colitis as compared to other diarrhoeal diseases and healthy controls.

Methods: Fifty-five consecutive patients presenting chronic watery diarrhoea and 12 healthy controls were included. Faecal samples were collected three days before and 30 days after PEG in patients and controls for microbiome analysis.

Results: Clinical remission was observed in 53% of microscopic colitis patients, and in 32% of non-microscopic colitis patients (p = 0.16). Considering patients with persisting diarrhoea after colonoscopy, 71% of non-microscopic colitis patients had bile acid diarrhoea. Baseline Shannon Index was lower in diarrhoea groups than in healthy controls (p = 0.0025); there were no differences between microscopic colitis, bile-acid diarrhoea and functional diarrhoea. The microbial dysbiosis index was significantly higher in microscopic colitis than in bile acid diarrhoea plus functional diarrhoea (p = 0.0095), but no bacterial species showed a significantly different relative abundance among the diarrheal groups.

Conclusions: Dysbiosis is a feature in active microscopic colitis, but loss of microbial diversity was similar in all diarrheal groups, suggesting that faecal microbial changes are not due to microscopic colitis itself but associated with stool form. A considerable number of microscopic colitis patients achieved clinical remission after colonoscopy, but we were unable to demonstrate related PEG-induced changes in faecal microbiome.

Keywords: Dysbiosis; Faecal microbiome; Microscopic colitis; Polyethylene glycol.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Boxplot describing the comparison of baseline alpha diversity (Shannon index) between patients with microscopic colitis (MC), functional diarrhoea plus bile acid diarrhoea (FD + BAD) and healthy controls
Fig. 2
Fig. 2
Boxplot describing the comparison of baseline microbial dysbiosis Index (MD-index) between patients with microscopic colitis (MC), and functional diarrhoea plus bile acid diarrhoea (FD + BAD)
Fig. 3
Fig. 3
Boxplots describing the evolution of Shannon index 30-days after colonoscopy in both diarrhoeal groups and healthy controls (Repeated measures ANOVA: p = 0.015; *p = 0.0025 vs. HC; **p = 0.049 vs. HC;p = 0.03 vs. 30-days) (MC microscopic colitis, FD functional diarrhoea, BAD bile acid diarrhoea, HC healthy controls)
Fig. 4
Fig. 4
Boxplots describing the evolution of microbial dysbiosis index 30-days after colonoscopy in diarrhoeal groups (MC microscopic colitis, FD functional diarrhoea, BAD bile acid diarrhoea). *p = 0.014 vs. FD and BAD

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