School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia.
NHMRC Centre for Research Excellence in Digestive Health, University of Newcastle, Newcastle, NSW, Australia.
J Gastroenterol Hepatol. 2023 Jul;38(7):1028-1039. doi: 10.1111/jgh.16142. Epub 2023 Feb 26.
BACKGROUND AND AIMS: The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the microbiota and metabolome associations in asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease (SUDD), and diverticulitis pathophysiology. METHODS: Seven databases were searched for relevant studies published up to September 28, 2022. Data were screened in Covidence and extracted to Excel. Critical appraisal was undertaken using the Newcastle Ottawa Scale for case/control studies. RESULTS: Of the 413 papers screened by title and abstract, 48 full-text papers were reviewed in detail with 12 studies meeting the inclusion criteria. Overall, alpha and beta diversity were unchanged in diverticulosis; however, significant changes in alpha diversity were evident in diverticulitis. A similar Bacteroidetes to Firmicutes ratio compared with controls was reported across studies. The genus-level comparisons showed no relationship with diverticular disease. Butyrate-producing microbial species were decreased in abundance, suggesting a possible contribution to the pathogenesis of diverticular disease. Comamonas species was significantly increased in asymptomatic diverticulosis patients who later developed diverticulitis. Metabolome analysis reported significant differences in diverticulosis and SUDD, with upregulated uracil being the most consistent outcome in both. No significant differences were reported in the mycobiome. CONCLUSION: Overall, there is no convincing evidence of microbial dysbiosis in colonic diverticula to suggest that the microbiota contributes to the pathogenesis of asymptomatic diverticulosis, SUDD, or diverticular disease. Future research investigating microbiota involvement in colonic diverticula should consider an investigation of mucosa-associated microbial changes within the colonic diverticulum itself.
背景与目的:微生物群在憩室病和憩室疾病中的作用尚未得到充分探索。本系统综述旨在评估所有与无症状憩室病、有症状单纯性憩室病(SUDD)和憩室炎病理生理学相关的微生物组和代谢组关联的文献。
方法:检索了截至 2022 年 9 月 28 日发表的相关文献,共 7 个数据库。在 Covidence 中筛选数据并提取到 Excel 中。使用纽卡斯尔-渥太华量表对病例对照研究进行批判性评价。
结果:通过标题和摘要筛选出 413 篇论文,有 48 篇全文论文进行了详细审查,其中 12 项研究符合纳入标准。总体而言,憩室病的 alpha 和 beta 多样性没有变化;然而,憩室炎的 alpha 多样性发生了显著变化。与对照组相比,研究报告的拟杆菌门与厚壁菌门的比例相似。属水平的比较与憩室疾病无关。但产生丁酸盐的微生物物种丰度降低,提示其可能对憩室疾病的发病机制有贡献。无症状憩室病患者中 Comamonas 物种显著增加,这些患者后来发展为憩室炎。代谢组分析报告了憩室病和 SUDD 的显著差异,其中尿嘧啶上调是两者最一致的结果。真菌组没有报告显著差异。
结论:总体而言,结肠憩室中没有令人信服的微生物失调证据表明微生物群有助于无症状憩室病、SUDD 或憩室疾病的发病机制。未来研究应考虑调查结肠憩室本身中黏膜相关微生物变化,以调查微生物群在结肠憩室中的参与情况。
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