Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Turk J Gastroenterol. 2021 Jan;32(1):42-52. doi: 10.5152/tjg.2020.19995.
BACKGROUND/AIMS: Patients with achalasia have a high incidence of esophageal squamous cell carcinoma (ESCC), which may be associated with alterations in oral and esophageal microbiota caused by food stasis. This study compared the oral and esophageal microbiota of patients with achalasia before and after peroral endoscopic myotomy (POEM). It also compared patients with achalasia to those with ESCC.
The study prospectively examined 6 patients with achalasia and 14 with superficial ESCC. Oral samples obtained from the buccal mucosa using a swab and esophageal samples obtained from the mid-esophagus using a brush via endoscopy were analyzed by 16S rRNA metagenome sequencing. Additionally, endoscopic and histological findings of patients with achalasia before and after POEM were prospectively compared.
In patients with achalasia, Streptococcus was most abundant in both the oral and the esophageal microbiota, and these microbiota were significantly different. Although the overall structure of the oral and esophageal microbiota did not change after POEM, the relative abundance rate of Haemophilus and Neisseria increased in the esophagus, and endoscopic findings of inflammation improved after POEM (P = .04). The relative abundance of microbiota was not different among patients with achalasia from those with ESCC.
The oral and esophageal microbiota were significantly different in patients with achalasia, and some of the composition of the esophageal microbiota changed after POEM. However, these findings and disease-specific microbiota should be further evaluated in large-scale studies.
背景/目的：贲门失弛缓症患者的食管鳞状细胞癌（ESCC）发病率较高，这可能与食物淤滞引起的口腔和食管微生物群改变有关。本研究比较了经口内镜肌切开术（POEM）前后贲门失弛缓症患者的口腔和食管微生物群，并将贲门失弛缓症患者与 ESCC 患者进行了比较。
本研究前瞻性检查了 6 例贲门失弛缓症患者和 14 例浅表性 ESCC 患者。使用拭子从颊黏膜获得口腔样本，使用刷子通过内镜从食管中段获得食管样本，通过 16S rRNA 宏基因组测序进行分析。此外，前瞻性比较了 POEM 前后贲门失弛缓症患者的内镜和组织学发现。
在贲门失弛缓症患者中，口腔和食管微生物群中最丰富的是链球菌，且这些微生物群有显著差异。尽管 POEM 后口腔和食管微生物群的整体结构没有改变，但食管中嗜血杆菌和奈瑟菌的相对丰度增加，POEM 后炎症的内镜发现得到改善（P =.04）。贲门失弛缓症患者与 ESCC 患者的微生物群丰度无差异。
贲门失弛缓症患者的口腔和食管微生物群有显著差异，POEM 后食管微生物群的某些组成发生了变化。然而，这些发现和疾病特异性微生物群应在大规模研究中进一步评估。
