Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, China.
Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
EBioMedicine. 2018 Sep;35:87-96. doi: 10.1016/j.ebiom.2018.08.028. Epub 2018 Aug 23.
Helicobacter pylori (H. pylori) infection is associated with remodeling of gastric microbiota. However, comprehensive analyses of the impact of H. pylori infection, eradication therapy and probiotic supplementation on gut microbiota are still lacking. We aimed to provide evidence for clinical decision making.
Seventy H. pylori-positive and 35 H. pylori-negative patients (group C) were enrolled. H. pylori-positive patients were randomly assigned to group A (14-day bismuth-containing quadruple therapy) and group B (quadruple therapy supplemented with Clostridium butyricum). Stool samples of group A and B were collected on day 0, 14 and 56 while stool samples of group C were collected on day 0. Gut microbiota was investigated by 16S rRNA sequencing.
The Sobs index (richness estimator) was significantly higher in H. pylori-positive samples than H. pylori-negative samples (p < .05). Several metabolic pathways were more abundant in H. pylori-positive communities while some disease-associated pathways had higher potential in H. pylori-negative community through KEGG pathway analysis. Abundances of most butyrate-producing bacteria significantly decreased, while several detrimental bacteria increased after eradication therapy. Probiotic supplementation was associated with improved gastrointestinal symptoms as well as increased Bacteroidetes:Firmicutes ratio.
While H. pylori infection may not be necessarily detrimental in all patients, eradication of H. pylori was associated with widespread changes in gut microbial ecology and structure. Probiotic supplementation could relieve more gastrointestinal symptoms by inducing alterations in gut microbiota and host immune responses. As such, the decision to eradicate H. pylori should be based on comprehensive analysis of individual patients.
幽门螺杆菌（H. pylori）感染与胃微生物群的重塑有关。然而，综合分析 H. pylori 感染、根除治疗和益生菌补充对肠道微生物群的影响仍然缺乏。我们旨在为临床决策提供证据。
纳入 70 例 H. pylori 阳性和 35 例 H. pylori 阴性患者（C 组）。H. pylori 阳性患者被随机分为 A 组（14 天铋四联疗法）和 B 组（四联疗法补充丁酸梭菌）。A 组和 B 组的粪便样本分别于第 0、14 和 56 天采集，C 组的粪便样本于第 0 天采集。通过 16S rRNA 测序研究肠道微生物群。
H. pylori 阳性样本的 Sobs 指数（丰富度估计值）明显高于 H. pylori 阴性样本（p <.05）。通过 KEGG 途径分析发现，H. pylori 阳性群落中存在更多的代谢途径，而 H. pylori 阴性群落中存在更高的与疾病相关的途径。大多数产生丁酸的细菌丰度显著降低，而一些有害细菌在根除治疗后增加。益生菌补充与改善胃肠道症状以及增加拟杆菌门/厚壁菌门比值有关。
虽然 H. pylori 感染在所有患者中不一定是有害的，但 H. pylori 的根除与肠道微生物生态和结构的广泛变化有关。益生菌补充可以通过诱导肠道微生物群和宿主免疫反应的改变来缓解更多的胃肠道症状。因此，根除 H. pylori 的决定应基于对个体患者的综合分析。
