Abstract
BackgroundBile reflux can lead to inflammation and increased intestinal metaplasia. Since bile acids can influence the gastrointestinal environment, it is possible that bile reflux may alter the gastric microbiota and potentially the oral or gut microbiota. Bile acids have a very complex interrelationship with microbiota. We aimed to explore the characteristics of the digestive tract microbiota and bile acids profile in bile reflux patients.MethodsThis study included 20 chronic gastritis patients with bile reflux and 20 chronic gastritis patients without bile reflux. Saliva, gastric fluid, and fecal samples were collected for bile acid testing. Buccal mucosal swabs, gastric mucosal tissues, and feces were collected for bacteria detection. The UPLC-MS/MS examined bile acids profiles. 16S rRNA gene sequencing was used to analyze the bacterial profile.ResultsBilirubin in the blood increased in bile reflux patients. No other clinical factors were identified to be significantly associated with bile reflux. 12-DHCA, 6,7-diketo LCA, and βHDCA decreased while TUDCA increased in saliva of bile reflux patients. Streptococcus, Capnocytophaga, Neisseria, and Actinobacillus decreased in oral mucosa of bile reflux patients while Helicobacter, Prevotella, and Veillonella increased. Gastric bile acid levels were generally higher in bile reflux patients. Gastric mucosal microbiota was highly stable. The changes in fecal bile acids were insignificant. Bifidobacterium, Prevotella_2, Ruminococcus, Weissella, Neisseria, and Akkermansia decreased in fecal samples from bile reflux patients; while Alloprevotella, Prevotella_9, Parabacteroides, and Megamonas increased.ConclusionOur results demonstrate that bile reflux significantly alters the oral, gastric, and intestinal bile acids profiles but only influences the oral and gut microbiota composition. These findings indicate that bile reflux can modulate the gastrointestinal microbiota in a site-specific manner.
Highlights
Bile reflux is the reflux of duodenal fluid containing excess bile into the stomach
Blood bilirubin in the bile reflux group increased compared to the control group (p < 0.05) but still normal
No clinical symptom, living habit or psychiatric factor were found to be significantly associated with bile reflux
Summary
Bile reflux is the reflux of duodenal fluid containing excess bile into the stomach. Gastrointestinal movement dysfunction and gastrointestinal hormone secretion may contribute to bile reflux (Dewar et al, 1983; Wilson et al, 1993). After bile acids go into the stomach, they turn into free bile acids in an acidic environment, destroying the structure of epithelial cells. Bile acid conjugation with gastric acid enhances the viability of acid hydrolase and destroys lysosomal membrane, resulting in hydrogen ion diffusion in the reverse direction. Activated mast cells release histamine and cause gastric acid and pepsin secretion, which aggravate mucosal damage. The diagnosis of bile reflux lacks internationally acknowledged standards. Since bile acids can influence the gastrointestinal environment, it is possible that bile reflux may alter the gastric microbiota and potentially the oral or gut microbiota. Bile acids have a very complex interrelationship with microbiota. We aimed to explore the characteristics of the digestive tract microbiota and bile acids profile in bile reflux patients
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