The Duodenal Microbiota Composition of Adult Celiac Disease Patients Is Associated with the Clinical Manifestation of the Disease

*Finnish Red Cross Blood Service, Helsinki, Finland †Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland ‡Pediatric Research Center, Tampere University Hospital, University of Tampere, Tampere, Finland.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 03/2013; 19(5). DOI: 10.1097/MIB.0b013e31828029a9
Source: PubMed


Celiac disease is classically manifested in the gastrointestinal (GI) tract but extraintestinal symptoms, such as dermatitis herpetiformis (DH), are also common. Besides several well-known shared genetic risk factors and an environmental trigger, gliadin, factors determining the clinical outcome of the disease are not known. In this study, the role of duodenal microbiota in the celiac disease outcome was studied by analyzing mucosa-associated microbiota in celiac disease patients with a variety of intestinal and extraintestinal symptoms.

Microbiota in duodenal biopsy samples obtained from 33 patients with celiac disease with GI, DH, anemia, or mixed symptoms, as well as screen-detected asymptomatic celiac disease and 18 control subjects were analyzed using PCR denaturing gradient gel electrophoresis and a subset of samples additionally by the 16S ribosomal RNA gene sequencing.

The composition and diversity of mucosal microbiota was associated with the manifestation of celiac disease when analyzed using PCR denaturing gradient gel electrophoresis and the 16S ribosomal RNA gene sequencing. The patients with celiac disease with GI symptoms or anemia had lower microbial diversity than those with DH. Moreover, the patients with GI symptoms had different intestinal microbiota composition and structure, dominated by Proteobacteria, in comparison to those with DH or control subjects (patients with dyspepsia). The relatively similar intestinal microbiota composition in the control subjects and those with DH was characterized by the high abundance of Firmicutes.

The two common outcomes of celiac disease, classical GI and extraintestinal manifestations, had marked differences on the diversity and composition of intestinal microbiota. This association suggested that intestinal microbiota may have a role in the manifestation of the disease.

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    • "Most observational studies in children and adults have shown intestinal dysbiosis (i.e., altered gut microbiota composition or function) in celiac disease patients, untreated and treated with a gluten-free diet, compared to healthy controls33343536373839. Celiac disease patients with gastrointestinal symptoms are also known to have a different microbiota compared to patients with dermatitis herpetiformis and controls, suggesting that the microbiota is involved in disease manifestation [40]. Furthermore, a dysbiotic microbiota seems to be associated with persistent gastrointestinal symptoms in treated celiac disease patients, suggesting its pathogenic implication in these particular cases [41]. "

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    • "Thus far, there does not appear to be a uniform " CD microbiome " to be found from these studies, with complicating factors being the variations in anatomical location from which samples were acquired, experimental methodology, and the inherent heterogeneity found in CD. In fact, one study has highlighted the differences that are found in patients depending on the presence of extraintestinal symptoms [59], while others have demonstrated differences between active CD patients and patients on a gluten free diet [60]. Below we discuss how having a dysregulated microbiome can aid in reaching the threshold necessary to develop CD. "
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