Levin Daniel, De Palma Giada, Zou Hannah, Bazzaz Ava Hadi Zadeh, Verdu Elena, Baker Barbara, Pinto-Sanchez Maria Ines, Khalidi Nader, Larché Maggie J, Beattie Karen A, Bercik Premysl
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
J Scleroderma Relat Disord. 2021 Oct;6(3):290-298. doi: 10.1177/23971983211032808. Epub 2021 Jul 24.
Gastrointestinal manifestations of systemic sclerosis affect up to 90% of patients, with symptoms including diarrhea and constipation. Small intestinal bacterial overgrowth is a condition associated with increased numbers of pathogenic bacteria in the small bowel. While currently unknown, it has been suggested that dysregulation of the fecal microbiota may play a role in the development of systemic sclerosis and small intestinal bacterial overgrowth.
Our study aimed to describe the fecal microbiota of patients with systemic sclerosis and compare it between those with and without a diagnosis of small intestinal bacterial overgrowth. We also compared the fecal microbiota of systemic sclerosis patients with that of healthy controls to understand the association between particular bacterial taxa and clinical gastrointestinal manifestations of systemic sclerosis.
A total of 29 patients with systemic sclerosis underwent breath testing to assess for small intestinal bacterial overgrowth, provided stool samples to determine taxonomic assignments, and completed the University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0, which details symptoms and quality-of-life factors. Stool samples were compared between systemic sclerosis patients with and without small intestinal bacterial overgrowth, and between patients with systemic sclerosis and a healthy control cohort (n = 20), aged 18-80 years.
Fecal microbiome analyses demonstrated differences between systemic sclerosis patients with and without small intestinal bacterial overgrowth and differences in the diversity of species between healthy controls and patients with systemic sclerosis. Trends were also observed in anticentromere antibody systemic sclerosis patients, including higher spp. levels associated with increased methane levels of breath gas testing and higher spp. levels associated with increased rates of fecal soiling.
Our results suggest that changes to the fecal microbiome occur in patients with small intestinal bacterial overgrowth and systemic sclerosis when compared to healthy controls. As a cross-sectional study, the potential pathophysiologic role of an altered microbiome in the development of systemic sclerosis was not considered and hence needs to be further investigated.
系统性硬化症的胃肠道表现影响高达90%的患者，症状包括腹泻和便秘。小肠细菌过度生长是一种与小肠中病原菌数量增加相关的病症。虽然目前尚不清楚，但有人认为粪便微生物群失调可能在系统性硬化症和小肠细菌过度生长的发展中起作用。
我们的研究旨在描述系统性硬化症患者的粪便微生物群，并比较有和没有小肠细菌过度生长诊断的患者之间的差异。我们还比较了系统性硬化症患者与健康对照者的粪便微生物群，以了解特定细菌分类群与系统性硬化症临床胃肠道表现之间的关联。
共有29例系统性硬化症患者接受了呼气试验以评估小肠细菌过度生长，提供粪便样本以确定分类归属，并完成了加利福尼亚大学洛杉矶分校硬皮病临床试验联盟胃肠道2.0版，该版本详细描述了症状和生活质量因素。比较了有和没有小肠细菌过度生长的系统性硬化症患者之间的粪便样本，以及系统性硬化症患者与年龄在18至80岁之间的健康对照队列（n = 20）之间的粪便样本。
粪便微生物组分析表明，有和没有小肠细菌过度生长的系统性硬化症患者之间存在差异，健康对照者与系统性硬化症患者之间的物种多样性也存在差异。在抗着丝点抗体系统性硬化症患者中也观察到了趋势，包括与呼气试验中甲烷水平升高相关的较高 菌水平，以及与粪便污染率升高相关的较高 菌水平。
我们的结果表明，与健康对照者相比，小肠细菌过度生长和系统性硬化症患者的粪便微生物组发生了变化。作为一项横断面研究，未考虑微生物组改变在系统性硬化症发展中的潜在病理生理作用，因此需要进一步研究。
