Abstract Background The gut microbiome is involved in the pathogenesis of CD, but the extent to which the oral microbiome contributes to this—and how it can be utilised for disease monitoring and therapeutics—remains under-explored. We aimed to characterise compositional differences in the oral microbiome of patients with IBD by conducting a systematic review and meta-analysis of the literature. Methods Medline, Embase, Web of Science, Cochrane, and SCOPUS were searched for articles published from inception to 1st February 2024. Primary screening and extraction were performed in duplicate. The extracted dataset included: disease phenotype, sampling data, diversity metrics, relative abundance analysis and sequencing/metadata availability. Random effects meta-analysis of the standardised mean difference of Shannon diversity was performed for IBD sub-types and disease activity. Results The initial search identified 1367 after removing duplicates; 37 studies were selected for full-text review, with 22 meeting the inclusion criteria. (Figure 1) Alpha diversity was reported in 20/22 (91%) of studies. Comparing salivary Shannon diversity of 976 undifferentiated IBD patients with 566 controls shows a significant reduction in patients with IBD (standardised mean difference [95% CI]: -0.29 [-0.54, -0.05]). In patients with high disease activity, there was a significant reduction in salivary Shannon diversity (IBD n = 133, control n = 181) (standardised mean difference [95% CI]: -0.51 [-0.98, -0.04]), which is lost when low activity patients are examined (IBD n = 128, control n = 170) (standardised mean difference [95% CI]: -0.12 [-0.46, 0.22]). (Figure 2) When examining beta diversity, significant dissimilarity in community composition between patients with IBD and controls was reported in 15/20 (75%) of studies. Relative abundance data of oral sites at a genus level was reported in 11/22 (50%) of studies. Changes are most frequently reported in the dominant phyla of the oral cavity (Bacillota, Bacteroidota, Actinobacter, and Pseudomonadota). The most frequently increased genera in IBD patients were Prevotella (4/11, 36%), Veilonella (3/11, 27%), Atopobium (3/11, 27%), and Megasphaera (3/11, 27%). Conclusion Based on this systematic review, there is evidence of distinct alterations in the oral microbiome composition of patients with IBD compared to controls which underscores the role of the oral microbiome as a potential indicator of downstream dysbiosis and crucial early immune-crosstalk in the oral cavity.
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