Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Feb 15, 2018; 9(1): 18-27
Published online Feb 15, 2018. doi: 10.4291/wjgp.v9.i1.18
Abundance of Enterobacteriaceae in the colon mucosa in diverticular disease
Caroline Linninge, Bodil Roth, Charlotte Erlanson-Albertsson, Göran Molin, Ervin Toth, Bodil Ohlsson
Caroline Linninge, Göran Molin, Department of Food Technology, Engineering and Nutrition, Lund University, Lund S-223 63, Sweden
Bodil Roth, Bodil Ohlsson, Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö S-205 02, Sweden
Charlotte Erlanson-Albertsson, Appetite Regulation Unit, Department of Experimental Medical Science, Lund University, Lund S-222 41, Sweden
Ervin Toth, Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö S-205 02, Sweden
Author contributions: Roth B, Erlanson-Albertsson C, Molin G, Toth E, and Ohlsson B designed the study; Toth E was responsible for the endoscopic examinations and biopsy sampling; Linninge C and Roth B performed the microbial examinations; Ohlsson B wrote the initial draft of the manuscript; all authors contributed to the intellectual criticism of the manuscript and accepted the final version.
Supported by Development Foundation of Region Skåne (BO), No. F2014/354.
Institutional review board statement: The study was reviewed and approved by the Ethics Review Board of Lund University (2013/903).
Informed consent statement: The subjects provided written, informed consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interests to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at bodil.ohlsson@med.lu.se. Consent from participants was not obtained for data sharing, but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Bodil Ohlsson, MD, PhD, Professor, Department of Internal Medicine, Skåne University Hospital, Lund University, Jan Waldenströms Street 15, Malmö S-205 02, Sweden. bodil.ohlsson@med.lu.se
Telephone: +46-40-331000 Fax: +46-40-336208
Received: August 30, 2017
Peer-review started: September 5, 2017
First decision: October 12, 2017
Revised: November 10, 2017
Accepted: December 6, 2017
Article in press: December 6, 2017
Published online: February 15, 2018
Abstract
AIM

To compare gut bacterial diversity and amount of Enterobacteriaceae in colonic mucosa between patients with and without diverticular disease (DD).

METHODS

Patients in a stable clinical condition with planned elective colonoscopy were included. Blood samples and colon mucosa biopsies were collected at the colonoscopy. Study questionnaires including questions about gastrointestinal symptoms were completed by the patients and physicians. DNA from mucosa samples was isolated and the amount of Enterobacteriaceae was estimated using PCR assay. Terminal restriction fragment length polymorphism was applied to assess microbial diversity. Diversity was estimated by calculations of richness (number of terminal restriction fragments) and Shannon-Wiener and Simpson’s indices.

RESULTS

A total of 51 patients were included, 16 patients with DD [68 (62-76) years] and 35 controls [62 (40-74) years] without any diverticula. Patients with DD had significantly higher levels of Enterobacteriaceae than those without DD (P = 0.043), and there was an inverse relationship between the amount of Enterobacteriaceae and the Simpson’s index (rs = -0.361, P = 0.033) and the Shannon-Wiener index (rs = -0.299, P = 0.081). The Simpson’s index (P = 0.383), Shannon-Wiener index (P = 0.401) or number of restrictions fragments (P = 0.776) did not differ between DD and controls. The majority of patients experienced gastrointestinal symptoms, and 22 patients (43.1%) fulfilled the criteria for irritable bowel syndrome, with no difference between the groups (P = 0.212). Demography, socioeconomic status, lifestyle habits, inflammatory biomarkers, or symptoms were not related to the amount of Enterobacteriaceae or bacterial diversity.

CONCLUSION

Patients with DD had higher amount of Enterobacteriaceae in the colon mucosa compared to patients without diverticula.

Keywords: Bacterial diversity, Diverticular disease, Enterobacteriaceae, Gut microbiota, Irritable bowel syndrome

Core tip: Colon mucosa biopsies were collected from consecutive patients (n = 51) at the time of elective colonoscopy. Patients were grouped into patients with diverticular disease (DD) (n = 16) and controls without any diverticula (n = 35). The amount of Enterobacteriaceae and bacterial diversity were analyzed. Patients with DD had significantly higher levels of Enterobacteriaceae than controls (P = 0.043). Bacterial diversity did not differ between groups. All but 8 patients exhibited some kind of gastrointestinal symptoms, and 22 patients (43.1%) fulfilled the criteria for irritable bowel syndrome, without difference between groups (P = 0.212). Demography, socioeconomic status, lifestyle habits, inflammatory parameters, or gastrointestinal symptoms did not affect the gut microbiota examined.