Bile duct colonization with Enterococcus sp. associates with disease progression in Primary Sclerosing Cholangitis
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Bile duct colonization with Enterococcus sp. associates with disease progression in Primary Sclerosing Cholangitis. / Zigmond, Ehud; Zecher, Britta Franziska; Bartels, Anna-Lena; Ziv-Baran, Tomer; Rösch, Thomas; Schachschal, Guido; Lohse, Ansgar W; Ehlken, Hanno; Schramm, Christoph .
In: CLIN GASTROENTEROL H, Vol. 21, No. 5, 05.2023, p. 1223-1232.e3.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Bile duct colonization with Enterococcus sp. associates with disease progression in Primary Sclerosing Cholangitis
AU - Zigmond, Ehud
AU - Zecher, Britta Franziska
AU - Bartels, Anna-Lena
AU - Ziv-Baran, Tomer
AU - Rösch, Thomas
AU - Schachschal, Guido
AU - Lohse, Ansgar W
AU - Ehlken, Hanno
AU - Schramm, Christoph
N1 - Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.
PY - 2023/5
Y1 - 2023/5
N2 - BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is characterized by chronic inflammation of the biliary mucosa. Bile ducts in PSC are often colonized with bacteria. Although accumulating evidence demonstrates the importance of microbiota for mucosal immunity, little is known about the impact of bile duct colonization with bacteria on the clinical course of PSC.METHODS: Bile samples were sent to culture during endoscopic retrograde cholangio-pancreatography before the administration of peri-interventional antibiotics. Procedures during overt bacterial cholangitis or with prior antibiotic treatment were excluded. The primary endpoint was defined as a composite clinical endpoint of decompensated cirrhosis and/or liver transplantation or death.RESULTS: A cohort of 189 patients with 591 bile fluid cultures was included. In multivariable Cox regression analysis, the presence of Enterococci (present in 28% of the patients), but not of other bacterial species, conferred risk of disease progression with a hazard ratio of 3.61 (95% confidence interval, 1.6-8.11; P = .002) to reach the composite clinical endpoint. Fungobilia, present in 19.6% of patients, was confirmed to associate with disease progression with a hazard ratio of 3.25 (95% confidence interval, 1.87-5.66; P < .001) to reach the composite clinical endpoint.CONCLUSIONS: The novel association of biliary colonization by Enterococci with disease progression underlines the importance of microbiota-mucosal interplay for the pathogenesis of PSC. These results should stimulate further mechanistic studies on the role of microbiota in PSC and highlight potential new therapeutic targets for a disease without effective treatment options.
AB - BACKGROUND & AIMS: Primary sclerosing cholangitis (PSC) is characterized by chronic inflammation of the biliary mucosa. Bile ducts in PSC are often colonized with bacteria. Although accumulating evidence demonstrates the importance of microbiota for mucosal immunity, little is known about the impact of bile duct colonization with bacteria on the clinical course of PSC.METHODS: Bile samples were sent to culture during endoscopic retrograde cholangio-pancreatography before the administration of peri-interventional antibiotics. Procedures during overt bacterial cholangitis or with prior antibiotic treatment were excluded. The primary endpoint was defined as a composite clinical endpoint of decompensated cirrhosis and/or liver transplantation or death.RESULTS: A cohort of 189 patients with 591 bile fluid cultures was included. In multivariable Cox regression analysis, the presence of Enterococci (present in 28% of the patients), but not of other bacterial species, conferred risk of disease progression with a hazard ratio of 3.61 (95% confidence interval, 1.6-8.11; P = .002) to reach the composite clinical endpoint. Fungobilia, present in 19.6% of patients, was confirmed to associate with disease progression with a hazard ratio of 3.25 (95% confidence interval, 1.87-5.66; P < .001) to reach the composite clinical endpoint.CONCLUSIONS: The novel association of biliary colonization by Enterococci with disease progression underlines the importance of microbiota-mucosal interplay for the pathogenesis of PSC. These results should stimulate further mechanistic studies on the role of microbiota in PSC and highlight potential new therapeutic targets for a disease without effective treatment options.
U2 - 10.1016/j.cgh.2022.09.006
DO - 10.1016/j.cgh.2022.09.006
M3 - SCORING: Journal article
C2 - 36116754
VL - 21
SP - 1223-1232.e3
JO - CLIN GASTROENTEROL H
JF - CLIN GASTROENTEROL H
SN - 1542-3565
IS - 5
ER -
