Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Gastroenterology Unit of Pavia Institute, University of Pavia, Pavia, Italy.
Laboratory of Immunology and Genetic Analysis, Department of Earth and Environmental Science, University of Pavia, Pavia, Italy; Centre for Health Technologies, University of Pavia, Pavia, Italy.
Dig Liver Dis. 2021 Aug;53(8):972-979. doi: 10.1016/j.dld.2021.02.019. Epub 2021 Mar 16.
Duodenal dysbiosis has been suggested to possibly influence the clinical manifestations of coeliac disease (CD), both at onset and when symptoms persist despite a gluten-free diet (GFD).
To evaluate the relationship between duodenal microbiota composition and: i) clinical phenotype of untreated CD (UCD); ii) presence and type of persistent symptoms despite a satisfactory serological and histological response to a strict GFD.
Duodenal microbiota was analyzed by 16S rRNA sequencing and compared with i) clinical features in 12 adult UCD patients; ii) presence/absence and type of persistent symptoms (diarrhea-predominant vs. non-diarrhea predominant) in 25 adult treated coeliac patients (TCD) on a strict GFD.
UCD with iron deficiency anemia (IDA) had a pro-inflammatory shift in their duodenal microbiota (reduction of Firmicutes, p = 0.03; increase of beta-Proteobacteria, p = 0.02) than those without IDA. TCD with persistent diarrhea showed a reduction of Actinobacteria (p = 0.03) and Rothia spp (p = 0.046) compared to TCD suffering from other type of persistent symptoms.
A distinctive duodenal microbiota profile is associated with IDA in UCD, and diarrhea-predominant persistent symptoms in TCD. Clinical interventions may include reconsidering patients presenting with IDA as a specific disease subtype, and dietary rebalancing if diarrhea persists despite histological response to a GFD.
十二指肠菌群失调可能会影响乳糜泻（CD）的临床表现，无论是在发病时，还是在尽管遵循无麸质饮食（GFD）但症状仍持续存在时。
评估十二指肠微生物群落组成与以下方面之间的关系：i）未经治疗的 CD（UCD）的临床表型；ii）尽管对严格 GFD 的血清学和组织学反应令人满意，但仍存在持续性症状及其类型。
通过 16S rRNA 测序分析十二指肠微生物群，并将其与 i）12 例成年 UCD 患者的临床特征进行比较；ii）25 例成年 TCD 在严格 GFD 上存在/不存在持续性症状（腹泻为主型与非腹泻为主型）及其类型进行比较。
与无 IDA 的 UCD 相比，IDA 的 UCD 其十二指肠菌群出现促炎偏移（厚壁菌门减少，p=0.03；β变形菌门增加，p=0.02）。与患有其他持续性症状的 TCD 相比，持续性腹泻的 TCD 中放线菌（p=0.03）和罗特氏菌属（p=0.046）减少。
UCD 中的 IDA 和 TCD 中的腹泻为主型持续性症状与特定的十二指肠微生物群谱相关。临床干预措施可能包括重新考虑 IDA 患者作为一种特定的疾病亚型，并在遵循 GFD 治疗后仍出现腹泻时进行饮食再平衡。
