Gastroenterologìa (Oct 2020)
Age peculiarities of intestinal microbiocenosis disorders in the patients with ulcerative colitis and Crohn’s disease
Abstract
Background. Inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn’s disease (CD) remain one of the most difficult and challenging gastroenterology problems. The impact of intestinal microflora and its changes on the development and progression of IBD has not been studied enough. The most dominant etiological hypothesis is that IBD is the result of an abnormal immune response to an altered intestinal microbiota caused by an environmental factor or pathogenic microorganisms in a genetically predisposed host. Altered gut microbiota dysbiosis in IBD is generally recognized, but the dependence of this change on the age still needs to be studied. The purpose of the study is to investigate the peculiarities of intestinal dysbiosis and the frequency of small intestinal bacterial overgrowth (SIBO) in patients with IBD depending on nosology and age. Materials and methods. One hundred and twenty patients with IBD aged 19 to 79 years (average (43.90 ± 1.40) years) were examined; among them 83 patients had UC, and 37 ones had CD. All patients were divided into two groups according to nosology and age. The patients underwent a hydrogen breath test to detect SIBO, bacteriological examination of feces, and short-chain fatty acid (SCFAs) chromatography in coprofiltrate. Results. The profound qualitative and quantitative changes of the colon microflora and high frequency of SIBO in patients with IBD were revealed. The dependence of changes in the microflora composition of the small and large intestine in a patient on age and nosology was discovered. The decrease in the concentration of Bifidobacteria in the content of the colon was found mostly in young patients with CD, while the decrease in the number of Lactobacilli was mostly found in elderly patients in both groups. The frequency of hemolytic biovars of Escherichia coli, opportunistic enterobacteria, and fungi of the genus Candida in the colon increased with age. There were changes in both the total content and indices of some SCFAs in patients of both groups versus healthy persons that indicated the suppression of the metabolic activity of normal microflora in patients. Decreased levels of acetic and butyric acid indicated the severity of suppression of the production of these metabolites. Conclusions. The elderly patients were found to have a greater tendency to develop SIBO, a decrease in the colon Lactobacilli concentration, as well as an increased frequency of detection of conditionally pathogenic flora and fungi of the genus Candida. In young patients, there is mainly a subcompensated form of dysbiosis with a decrease in the concentration of Bifidobacteria. With age, there is also suppression of acetic and butyric acid production. The results of this study will allow clinicians to select therapeutic tactics in these patients more carefully, namely, will influence the choice of drugs that modulate the intestinal microbiota, taking into account not only the nosology but also the patient’s age.
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