Basic Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2021; 27(5): 391-403
Published online Feb 7, 2021. doi: 10.3748/wjg.v27.i5.391
Changes in gut microbiota composition and diversity associated with post-cholecystectomy diarrhea
Yan-Dong Li, Bao-Ning Liu, Si-Hai Zhao, Yong-Li Zhou, Liang Bai, En-Qi Liu
Yan-Dong Li, Si-Hai Zhao, Laboratory Animal Center, Xi’an Jiaotong University Health Science Center, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Bao-Ning Liu, Research Institute of Atherosclerotic Disease and Laboratory Animal Center, School of Medicine, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
Yong-Li Zhou, Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710077, Shaanxi Province, China
Liang Bai, En-Qi Liu, Laboratory Animal Center, Institute of Atherosclerotic Disease, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Li YD and Liu EQ designed the study; Li YD, Liu BN, Zhao SH, Zhou YL and Bai L performed the experiments; Liu EQ and Zhao SH provided reagents and materials; Li YD and Liu BN analyzed the data; Li YD, Liu BN and Liu EQ wrote the main manuscript text and prepared the figures; all authors reviewed the manuscript.
Institutional review board statement: The study was undertaken with the approval of the Medical Ethics Board of the First Affiliated Hospital of Xi’an Medical University.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email address. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: En-Qi Liu, PhD, Director, Professor, Laboratory Animal Center, Institute of Atherosclerotic Disease, Xi’an Jiaotong University, No. 76 Yanta West Road, Xi’an 710061, Shaanxi Province, China. liuenqi@mail.xjtu.edu.cn
Received: October 12, 2020
Peer-review started: October 12, 2020
First decision: November 23, 2020
Revised: November 30, 2020
Accepted: December 17, 2020
Article in press: December 17, 2020
Published online: February 7, 2021
Abstract
BACKGROUND

Post-cholecystectomy diarrhea (PCD) frequently occurs in patients following gallbladder removal. PCD is part of the post-cholecystectomy (PC) syndrome, and is difficult to treat. After cholecystectomy, bile enters the duodenum directly, independent of the timing of meals. The interaction between the bile acids and the intestinal microbes is changed. Therefore, the occurrence of PCD may be related to the change in microbiota. However, little is known about the relationship between the gut microbiota and PCD.

AIM

To better understand the role of the gut microbiota in PCD patients.

METHODS

Fecal DNA was isolated. The diversity and profiles of the gut microbiota were analyzed by performing high-throughput 16S rRNA gene sequencing. The gut microbiota were characterized in a healthy control (HC) group and a PC group. Subsequently, the PC group was further divided into a PCD group and a post-cholecystectomy non-diarrhea group (PCND) according to the patients’ clinical symptoms. The composition, diversity and richness of microbial communities were determined and compared.

RESULTS

In the PC and HC groups, 720 operational taxonomic units (OTUs) were identified. The PC group had fewer OTUs than the HC group. β-diversity was decreased in the PC group. This indicated decreased microbial diversity in the PC group. Fifteen taxa with differential abundance between the HC and PC groups were identified. In the PCD group compared to the PCND group, significant decreases in microbial diversity, Firmicutes/Bacteroidetes ratio, and richness of probiotic microbiota (Bifidobacterium and Lactococcus), and an increase in detrimental microbiota (Prevotella and Sutterella) were observed. Moreover, a negative correlation was found between Prevotella and Bifidobacterium. Using a Kyoto Encyclopedia of Genes and Genomes functional analysis, it was found that the abundances of gut microbiota involved in lipid metabolism pathways were markedly lower in the PCD group compared to the PCND group.

CONCLUSION

This study demonstrated that gut dysbiosis may play a critical role in PCD, which provides new insights into therapeutic options for PCD patients.

Keywords: Cholecystectomy, Post-cholecystectomy, Diarrhea, 16S rRNA, Microbiota, Bifidobacterium

Core Tip: Post-cholecystectomy diarrhea (PCD) is difficult to treat. Approximately 12%-35.6% of post-cholecystectomy patients have varying degrees of chronic diarrhea. Little is known regarding the intestinal microbiota characteristics in PCD patients. High-throughput sequencing of the 16S rRNA gene was used to characterize the composition and diversity of the complex intestinal microbial community in PCD patients. The results indicates that decreased diversity and abundance of the microbial community in the PCD group may cause diarrhea. These findings demonstrate the association between PCD and the gut microbiota, especially regarding Prevotella and Bifidobacterium. Thus, this study provides new insights into potential therapeutics that could target the microbiota to attenuate PCD.