Abstract
Background and Aims: Gut microbiota recolonization after intestinal resection had been reported to be associated with post-operative recurrence in Crohn's disease (CD). However, the results of different studies are inconsistent and even contradictory. In addition, knowledge on the efficacy of microbial-based therapies in preventing post-operative recurrence of CD is limited. Therefore, the aim of this review was to investigate gut microbiota profiles in patients with CD before and after surgery and evaluate microbial-based therapies in preventing post-operative recurrence.Methods: Electronic databases were searched from inception to 31 June 2020 using predefined terms. Studies that investigated gut microbiota pre- and post-intestinal resection, and microbial-based therapies in preventing post-operative recurrence, were eligible. Study quality was assessed using either the Newcastle–Ottawa scale or Jadad scoring system.Results: Twelve studies investigating gut microbiota of CD patients suffering from operation, and other 12 studies evaluating the efficacy of antibiotics and probiotics, were included in our review. The mucosa-associated microbiota in surgical biopsy of CD patients is significantly distinct from that in normal mucosa from healthy subjects. Gut microbiota recolonization following surgery might be associated with post-operative recurrence in CD patients. Furthermore, CD patients with post-operative recurrence presented a gain in pro-inflammatory pathogenic bacteria and a loss in short-chain fatty acid-producing bacteria before and after surgery. However, no consistent bacteria or metabolites were found to predict the post-operative recurrence of CD. Additionally, microbial-based therapies are deficient and present restricted widespread clinical utility due to several deficiencies.Conclusion: Recurrence-associated bacteria observed pre- and post- operation might be promising in preventing the post-operative recurrence of CD. Furthermore, potential microbe biomarkers for predicting subsequent disease recurrence should be validated with larger sample sizes using more rigorous and standardized methodologies.
Highlights
Crohn’s disease (CD) is a chronic relapsing inflammatory bowel disease (IBD) with multifactorial pathogenesis and is characterized by recurrent transmural inflammation [1]
The articles were selected on the basis of certain criteria: observational studies that focused on gut microbiota profiles associated with the post-operative disease course in CD patients or clinical trials that evaluated the effect of microbial-based therapies on the prevention of the postoperative recurrence (PR) of CD
24 original articles were included in this systematic review (Figure 1). These articles included 12 studies reporting gut microbiota profiles in post-operative, and five and seven studies evaluating the efficacy of antibiotics and probiotics, respectively, in preventing the PR of CD [24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47]
Summary
Crohn’s disease (CD) is a chronic relapsing inflammatory bowel disease (IBD) with multifactorial pathogenesis and is characterized by recurrent transmural inflammation [1]. Operative management is not curative, and up to 75% of CD patients will experience postoperative disease recurrence (clinical, endoscopic, or surgical recurrence) over time [6,7,8]. Given the significant recurrence risk after surgical resection in CD, elucidating the specific factors that predispose patients to postoperative CD recurrence is a high priority. Gut microbiota recolonization after intestinal resection had been reported to be associated with post-operative recurrence in Crohn’s disease (CD). Knowledge on the efficacy of microbial-based therapies in preventing post-operative recurrence of CD is limited. The aim of this review was to investigate gut microbiota profiles in patients with CD before and after surgery and evaluate microbial-based therapies in preventing post-operative recurrence
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