Abstract
IntroductionChildren presenting for the first time with inflammatory bowel disease (IBD) offer a unique opportunity to study aetiological agents before the confounders of treatment. Microaerophilic bacteria can exploit the ecological niche of the intestinal epithelium; Helicobacter and Campylobacter are previously implicated in IBD pathogenesis. We set out to study these and other microaerophilic bacteria in de-novo paediatric IBD.Patients and Methods100 children undergoing colonoscopy were recruited including 44 treatment naïve de-novo IBD patients and 42 with normal colons. Colonic biopsies were subjected to microaerophilic culture with Gram-negative isolates then identified by sequencing. Biopsies were also PCR screened for the specific microaerophilic bacterial groups: Helicobacteraceae, Campylobacteraceae and Sutterella wadsworthensis. Results129 Gram-negative microaerophilic bacterial isolates were identified from 10 genera. The most frequently cultured was S. wadsworthensis (32 distinct isolates). Unusual Campylobacter were isolated from 8 subjects (including 3 C. concisus, 1 C. curvus, 1 C. lari, 1 C. rectus, 3 C. showae). No Helicobacter were cultured. When comparing IBD vs. normal colon control by PCR the prevalence figures were not significantly different (Helicobacter 11% vs. 12%, p = 1.00; Campylobacter 75% vs. 76%, p = 1.00; S. wadsworthensis 82% vs. 71%, p = 0.312).ConclusionsThis study offers a comprehensive overview of the microaerophilic microbiota of the paediatric colon including at IBD onset. Campylobacter appear to be surprisingly common, are not more strongly associated with IBD and can be isolated from around 8% of paediatric colonic biopsies. S. wadsworthensis appears to be a common commensal. Helicobacter species are relatively rare in the paediatric colon.Trial RegistrationThis study is publically registered on the United Kingdom Clinical Research Network Portfolio (9633).
Highlights
Children presenting for the first time with inflammatory bowel disease (IBD) offer a unique opportunity to study aetiological agents before the confounders of treatment
This study offers a comprehensive overview of the microaerophilic microbiota of the paediatric colon including at IBD onset
44 IBD subjects were diagnosed as Crohn’s disease (CD) (29), ulcerative colitis (UC) (13) and IBD-type unclassified (IBD-U) (2)
Summary
Children presenting for the first time with inflammatory bowel disease (IBD) offer a unique opportunity to study aetiological agents before the confounders of treatment. Microaerophilic bacteria can exploit the ecological niche of the intestinal epithelium; Helicobacter and Campylobacter are previously implicated in IBD pathogenesis. Paediatric inflammatory bowel disease (IBD) represents a variant phenotype characterised by more extensive disease activity at onset and a progressive course [1]. While paediatric disease represents a distinct phenotype of IBD, it is surprisingly not explained by a significantly different genotype [3]. Recent studies showing a rise in the incidence of IBD in childhood and, perhaps more worryingly, a younger age at onset in those affected support an urgent need for aetiological studies to explain these trends [4,5,6,7]. Recent genetic discoveries reinforce the essential role for host defence against infection in IBD pathogenesis [10]
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