A pilot study demonstrating the impact of surgical bowel preparation on intestinal microbiota composition following colon and rectal surgery

Nalluri, Harika; Bobel, Matthew C.; Nugent, Julia L.; Emanuelson, Ryan; Melton, Genevieve B.; Madoff, Robert D.; Jahansouz, Cyrus; Staley, Christopher; Gaertner, Wolfgang B.

doi:10.1038/s41598-022-14819-1

Cited by 24 publications

(37 citation statements)

References 41 publications

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“…While some studies report short term alterations of the intestinal microbiome (19)(20)(21), Drago et al ( 16) demonstrated significant and persisting changes regarding the abundance of different bacterial phyla after bowel preparation followed by colonoscopy. The bowel preparation decreased the abundance of Firmicutes, especially Lactobacilli which have a health-promoting effect, whereas Proteobacteria abundance is increased (16,22,23). In addition to the luminal microbiome, it has been shown that standard bowel cleansing adversely affects the mucosaassociated microbiota (24).…”

Section: Introductionmentioning

confidence: 99%

Application of a multispecies probiotic reduces gastro-intestinal discomfort and induces microbial changes after colonoscopy

Labenz

Borkenstein²,

Heil³

et al. 2023

Front. Oncol.

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Even after decades of research and pharmaceutical development, cancer is still one of the most common causes of death in the western population and the management of cancer will remain a major challenge of medical research. One of the most common types of cancer is colorectal cancer (CRC). Prevention by detection of early-stage precursors is the most reliable method to prevent CRC development. In dependence of age, familial predisposition, and other risk factors the preventative routine screening for CRC by colonoscopy should be performed at least twice in intervals of about ten years. Although colonoscopy is a life-saving clinical examination reducing both incidence and mortality of CRC significantly, it has still a bad reputation in the population as an uncomfortable procedure with unpleasant side effects lasting sometimes over days to weeks. These effects are most likely caused by the bowel preparation before colonoscopy, which is crucial for a successful colonoscopy with high quality. Beside pain, bleeding and other rare but severe complications of colonoscopy, cleaning of the intestinal mucosa alters the gut microbiome significantly and consistently. Abdominal pain, cramps, diarrhea, nausea, bloating, and constipation are common adverse events which can continue to affect patients for days or even weeks after the procedure. In this multicenter, placebo controlled, double blind clinical trial, we investigated the effect of an intervention with a multispecies probiotic formulation for 30 days on the adverse events due to bowel preparation. We show that the treatment of participants with the multispecies probiotic formulation decreases the number of days with constipation significantly, and reduced pain, bloating, diarrhea, and general discomfort. 16S based amplicon analyses reveal recovery of administered probiotic strains from stool samples and differences in alpha diversity dynamics with higher variability in the probiotic group compared to the placebo group. In conclusion, the probiotic ameliorates the side effects after colonoscopy and might be an important supplement to increase acceptance of this life-saving preventative examination. Further, we present here for the first time that probiotic intervention of only 30 days affects alpha diversity parameters in stool samples.

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Section: Introductionmentioning

confidence: 99%

Application of a multispecies probiotic reduces gastro-intestinal discomfort and induces microbial changes after colonoscopy

Labenz

Borkenstein²,

Heil³

et al. 2023

Front. Oncol.

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“…To better characterize the mechanism of bowel preparation, our group recently published a longitudinal pilot study investigating the impact of MBP versus combined MBP þ OA on compositional changes in the intestinal microbiota of patients undergoing colonoscopy (MBP only) or colon surgery (preoperative MBP þ OA). 38 Patients in the colonoscopy/MBP only cohort had minimal compositional shifts in their microbiome with rapid return to baseline, whereas those in the surgery/MBP þ OA group demonstrated decreased α diversity, larger shifts in composition that persisted for an average of 1 month, and increased abundances of Streptococcus, Enterococcus, and Lactobacillus. 38 Further study is underway to investigate the association of these microbial changes in the setting of bowel preparation with anastomotic leak.…”

Section: Effect Of Preoperative Bowel Preparation On Surgical Infecti...mentioning

confidence: 92%

“…38 Patients in the colonoscopy/MBP only cohort had minimal compositional shifts in their microbiome with rapid return to baseline, whereas those in the surgery/MBP þ OA group demonstrated decreased α diversity, larger shifts in composition that persisted for an average of 1 month, and increased abundances of Streptococcus, Enterococcus, and Lactobacillus. 38 Further study is underway to investigate the association of these microbial changes in the setting of bowel preparation with anastomotic leak. Ultimately, the compositional shifts caused by nonspecific microbial killing, as seen with current bowel preparation regimens, may adversely affect anastomotic healing.…”

Section: Effect Of Preoperative Bowel Preparation On Surgical Infecti...mentioning

confidence: 92%

The Influence of the Microbiome on Anastomotic Leak

Köhn

Jahansouz

2023

Clin Colon Rectal Surg

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Anastomotic leak, defined by the International Study Group of Rectal Cancer as “a communication between the intra- and extraluminal compartments owing to a defect of the integrity of the intestinal wall at the anastomosis,” is one of the most devastating complications in colorectal surgery. Much work has been done to identify causes of leak; however, despite advances in surgical technique, the prevalence of anastomotic leak has remained at around 11%. The potential causative role of bacteria in the etiopathology of anastomotic leak was established in the 1950s. More recently, alterations in the colonic microbiome have been shown to affect rates of anastomotic leak. Multiple perioperative factors that alter the homeostasis of the gut microbiota community structure and function have been linked to anastomotic leak after colorectal surgery. Here, we discuss the role of diet, radiation, bowel preparation, medications including nonsteroidal anti-inflammatory drugs, morphine, and antibiotics, and specific microbial pathways that have been implicated in anastomotic leak via their effects on the microbiome.

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“…The impact of the bowel preparation method itself on gut microbiota composition is still under question, with reports often not reaching consensus due to various reasons including lack of analytical depth (Nagata et al, 2019). A recent report highlights minor shifts in gut microbial composition in non-surgical patients undergoing MBP, but a substantial impact of MBP combined with oral antibiotics (neomycin) in the gut microbiota of surgery patients, with compositional changes persisting in the early postoperative period, with a later repopulation to baseline (Nalluri-Butz et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

The impact of cefuroxime prophylaxis on human intestinal microbiota in surgical oncological patients

Văcărean-Trandafir

Amărandi²,

Ivanov³

et al. 2023

Front. Microbiomes

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IntroductionThe intestinal microbiota is vital to human health, and has a profound influence on several biological processes including inflammation and pathogen resistance. Antibiotic intake greatly impacts bacterial diversity, can increase antibiotic resistance and impair the equilibrium between bacterial species. The key to grasping post-antibiotic effects on the gut microbiota rests on the implementation of a suitable procedure to isolate microbial DNA and a meticulous consideration of experimental sequencing artefacts.MethodsWe herein report the bacterial community dynamics of a cohort of 128 surgical oncology patients before and after the intravenous administration of cefuroxime, an antibiotic routinely used in surgical antibioprophylaxis with proven efficiency against both gram-positive and gram-negative bacteria. In our study, we analyzed patient fecal samples collected through rectal examination before and 7 days post cefuroxime treatment by employing a high-throughput sequencing assay which targets the V3–V4 region of the 16S rRNA gene. A first challenge in applying the study design was to extract an appropriate amount of DNA characteristic to the sampled microbiota, which implied the use of both mechanical (ceramic beads) and chemical (proteinase K, lysozyme and lysostaphin) lysis.ResultsGut microbiota richness and composition was significantly different between the two groups, but most differences were determined by additional perioperative procedures, rather than antibioprophylaxis. Intestinal microbiota composition was not significantly changed one week post cefuroxime treatment when compared to pre-treatment condition for patients without mechanical bowel preparation, but some loss in taxonomic variety could be observed.DiscussionTaken together, cefuroxime does not promote short-term dysbiosis in surgical patients without any additional perioperative procedures.

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A pilot study demonstrating the impact of surgical bowel preparation on intestinal microbiota composition following colon and rectal surgery

Cited by 24 publications

References 41 publications

Application of a multispecies probiotic reduces gastro-intestinal discomfort and induces microbial changes after colonoscopy

Application of a multispecies probiotic reduces gastro-intestinal discomfort and induces microbial changes after colonoscopy

The Influence of the Microbiome on Anastomotic Leak

The impact of cefuroxime prophylaxis on human intestinal microbiota in surgical oncological patients

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