Gastroenterology

Gastroenterology

Volume 135, Issue 2, August 2008, Pages 568-579.e2
Gastroenterology

Basic—Alimentary Tract
Biostructure of Fecal Microbiota in Healthy Subjects and Patients With Chronic Idiopathic Diarrhea

https://doi.org/10.1053/j.gastro.2008.04.017Get rights and content

Background & Aims: Dysbiosis is a key component of intestinal disorders. Our aim was to quantitatively access the biostructure of fecal microbiota in healthy subjects and patients with chronic idiopathic diarrhea and evaluate the responses to Saccharomyces boulardii treatment. Methods: We investigated punched fecal cylinders from 20 patients with chronic idiopathic diarrhea and 20 healthy controls using fluorescence in situ hybridization. Fluctuations in assembly of 11 bacterial groups were monitored weekly for 3 weeks before, during, and after oral S boulardii supplementation. Results: The structural organization of fecal microbiota in healthy subjects was stable and unaffected by S boulardii. The assembly of fecal microbiota in idiopathic diarrhea was markedly different, characterized by mucus depositions within feces; mucus septa and striae; marked reduction in concentrations of habitual Eubacterium rectale, Bacteroides, and Faecalibacterium prausnitzii groups; suppression of bacterial fluorescence in the center of the feces; increased concentrations and spatial shift of mucotrop bacteria to the fecal core; and increased concentrations of occasional bacteria. Except for elevated concentrations of some occasional bacterial groups, all parameters typical for diarrhea improved significantly with S boulardii treatment and most changes persisted after cessation of therapy. The improvement of the fecal microbiota was accompanied by partial (40%) and complete normalization (30%) of the diarrheal symptoms. Conclusions: The fecal microbiota is highly structured. Fluorescence in situ hybridization analysis allowed us to quantitatively study the dysbiotic changes. S boulardii significantly improved the fecal biostructure in patients with diarrhea but had no influence on the feces in healthy subjects.

Section snippets

Patients

Patients with chronic idiopathic diarrhea were recruited from the gastroenterology outpatient clinic of the Charité Hospital. All patients had a complete gastroenterological diagnostic investigation, including colonoscopy, gastroscopy, ultrasonography, and laboratory tests. The diagnosis of idiopathic (functional) diarrhea was made as described.5, 6 However, for this study, only patients with diarrhea of at least 12-month duration with a weekly average of ≥4 stools/day were included. Their ages

Compliance

Nine healthy controls and 2 patients with idiopathic diarrhea who were enrolled in the study failed to complete the study protocol and hence were excluded from the study and replaced by compliant subjects. The inability to collect stools with very loose consistency apparently accounted for the noncompliance in patients with diarrhea, whereas healthy subjects attributed their noncompliance to discomfort with handling of feces and/or lack of time. The overall readiness to participate in the study

Discussion

The analysis of the fecal microbiota in health and disease was generally regarded as highly unreliable, difficult to perform, and useless for the clinic.1, 2 Our study and another previous publication10 show that this is definitely not the case. Quantitative analysis of bacterial composition and fluorescence intensity in the spatial relation to the fecal core, surface, and mucus allow us to differentiate diseased and normal feces and to longitudinally follow-up the progression of the symptoms

References (10)

There are more references available in the full text version of this article.

Cited by (146)

View all citing articles on Scopus

The authors report that there is no conflict of interest to disclose.

View full text