Abstract
Background
Duodenal dysbiosis has been suggested to possibly influence the clinical manifestations
of coeliac disease (CD), both at onset and when symptoms persist despite a gluten-free
diet (GFD).
AIMS
To evaluate the relationship between duodenal microbiota composition and: i) clinical
phenotype of untreated CD (UCD); ii) presence and type of persistent symptoms despite
a satisfactory serological and histological response to a strict GFD.
Methods
Duodenal microbiota was analyzed by 16S rRNA sequencing and compared with i) clinical
features in 12 adult UCD patients; ii) presence/absence and type of persistent symptoms
(diarrhea-predominant vs. non-diarrhea predominant) in 25 adult treated coeliac patients
(TCD) on a strict GFD.
Results
UCD with iron deficiency anemia (IDA) had a pro-inflammatory shift in their duodenal
microbiota (reduction of Firmicutes, p = 0.03; increase of beta-Proteobacteria, p = 0.02) than those without IDA. TCD with persistent diarrhea showed a reduction of
Actinobacteria (p = 0.03) and Rothia spp (p = 0.046) compared to TCD suffering from other type of persistent symptoms.
Conclusion
A distinctive duodenal microbiota profile is associated with IDA in UCD, and diarrhea-predominant
persistent symptoms in TCD. Clinical interventions may include reconsidering patients
presenting with IDA as a specific disease subtype, and dietary rebalancing if diarrhea
persists despite histological response to a GFD.
Keywords
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Article info
Publication history
Published online: March 16, 2021
Accepted:
February 22,
2021
Received:
December 12,
2020
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
