Abstract
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory esophageal disease triggered by food antigens. Cumulative evidence supports the implication of microbiota and the innate immune system in the pathogenesis of EoE. Changes in the esophageal microbiome were investigated by applying 16S rRNA gene sequencing on esophageal biopsies of adult patients with active EoE at baseline (n = 30), and after achieving remission with either proton pump inhibitors (PPI, n = 10), swallowed topical corticosteroids (STC, n = 10) or food-elimination diets (FED, n = 10). Ten non-EoE biopsies were also characterized as controls. Compared to controls, no differences in alpha (intra-sample) diversity were found in EoE microbiota overall. However, it decreased significantly among patients who underwent FED. As for beta (inter-sample) diversity, non-EoE controls separated from EoE baseline samples. Post-treatment samples from patients treated with PPI and FED had a more similar microbiota composition, while those receiving STC were closer to controls. Differential testing of microbial relative abundance displayed significant changes for Filifactor, Parvimonas and Porphyromonas genera. Analysis of predicted functions indicated alterations in metabolic pathways and abundance of sulphur-cytochrome oxidoreductases. Our findings demonstrate changes in microbiota associated with EoE, as well as a treatment effect on the microbiome.
Highlights
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory esophageal disease triggered by food antigens
Esophageal biopsies were obtained via upper endoscopy of 30 adult patients diagnosed with EoE, at two different time points, and from 10 non-EoE controls
Analysis and clustering of microbial diversity identified two broad sample groups: one with a significantly higher alpha diversity, incorporating a greater proportion of EoE baseline samples; and another with overall lower alpha diversity and composed of an even mix of treatment types. These analyses showed that baseline EoE samples displayed an esophageal microbiota composition that differed to some extent from that present in non-EoE subjects, with food elimination diets (FED) and pump inhibitors (PPI) therapies leading to more similar esophageal microbiota compositions, while swallowed topical costicosteroids (STC)-treated patients appeared more similar to that of controls
Summary
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory esophageal disease triggered by food antigens. Changes in the esophageal microbiome were investigated by applying 16S rRNA gene sequencing on esophageal biopsies of adult patients with active EoE at baseline (n = 30), and after achieving remission with either proton pump inhibitors (PPI, n = 10), swallowed topical corticosteroids (STC, n = 10) or food-elimination diets (FED, n = 10). Abbreviations EoE Eosinophilic esophagitis FED Empiric food-elimination diets PPI Proton pump inhibitors STC Swallowed topical corticosteroids. Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus, which consists of a non-IgE-mediated response to antigens present in the diet. We aimed to investigate differences in the esophageal microbiota between pre-treatment and posttreatment biopsies, where subjects successfully achieved remission through treatment either with proton pump inhibitors (PPI), swallowed topical costicosteroids (STC), or use of empirical food elimination diets (FED). To our knowledge, this is the first microbiota research in EoE differentiating among the three major treatment options currently used to induce EoE remission
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