Zheng YM, Chen XY, Cai JY, Yuan Y, Xie WR, Xu JT, Xia HHX, Zhang M, He XX, Wu LH. Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease. World J Gastroenterol 2021; 27(6): 513-522 [PMID: 33642825 DOI: 10.3748/wjg.v27.i6.513]
Corresponding Author of This Article
Li-Hao Wu, MD, Associate Professor, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Research Center for Engineering Techniques of Microbiota-Targeted Therapies of Guangdong Province, No. 19 Nonglinxia Road, Yuexiu District, Guangzhou 510030, Guangdong Province, China. wulihao888@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ya-Mei Zheng, Xian-Yun Chen, Jie-Yi Cai, Yu Yuan, Wen-Rui Xie, Jia-Ting Xu, Xing-Xiang He, Li-Hao Wu, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Research Center for Engineering Techniques of Microbiota-Targeted Therapies of Guangdong Province, Guangzhou 510030, Guangdong Province, China
Harry Hua-Xiang Xia, Department of Science and Education, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510030, Guangdong Province, China
Min Zhang, Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510220, Guangdong Province, China
Author contributions: Zheng YM contributed to the study design, performed the experiments, and wrote the paper; Wu LH contributed to the study design, provided critical revision of the article for important intellectual content, and made final approval of the article; Chen XY, Cai JY, Zhang M, and Xia HHX designed the study and contributed to the analysis and interpretation of the data; Yuan Y, Xie WR, He XX, and Xu JT provided clinical advice and supervised the report.
Institutional review board statement: This retrospective study was approved by the Ethics Committee of Guangdong Pharmaceutical University (Approval No. Yilun Shen[2019] No. 93 01).
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Hao Wu, MD, Associate Professor, Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Research Center for Engineering Techniques of Microbiota-Targeted Therapies of Guangdong Province, No. 19 Nonglinxia Road, Yuexiu District, Guangzhou 510030, Guangdong Province, China. wulihao888@126.com
Received: November 29, 2020 Peer-review started: November 29, 2020 First decision: December 8, 2020 Revised: December 20, 2020 Accepted: January 12, 2021 Article in press: January 12, 2021 Published online: February 14, 2021
Abstract
BACKGROUND
The pathogenesis of gastroesophageal reflux disease (GERD) is closely associated with the intestinal bacteria composition and their metabolites.
AIM
To investigate whether washed microbiota transplantation (WMT) improves symptoms of nonerosive reflux disease (NERD) with proton pump inhibitor (PPI) dependency.
METHODS
Patients with recurrent NERD and PPI dependency at the First Affiliated Hospital of Guangdong Pharmaceutical University from 2017 to 2018 were included and divided into a WMT or PPI group treated with PPI with/without WMT. The endpoint was NERD symptom frequency evaluated 1 mo after WMT using reflux disease questionnaire (RDQ) and GERD questionnaire (GERDQ) scores, remission time, PPI dose, and the examination of intestinal mucosal barrier function.
RESULTS
In the WMT (n = 15) and PPI (n = 12) groups, the total remission rate at 1 mo after treatment was 93.3% vs 41.7%. Compared with the PPI group, the WMT group showed better results in GERDQ (P = 0.004) and RDQ (P = 0.003) and in remission months (8 vs 2, P = 0.002). The PPI dose was reduced to some extent for 80% of patients in the WMT group and 33.3% in the PPI group. In 24 patients, intestinal mucosal barrier function was examined before treatment, and changes in the degree of damage were observed in 13 of these patients after treatment. Only one of the 15 patients had minor side effects, including a mushy stool two or three times a day, which resolved on their own after 1 wk.
CONCLUSION
This study is the first to demonstrate that WMT may be safe and effective for relieving NERD symptoms and reducing PPI dependency and recurrence.
Core Tip: In this study, we demonstrated for the first time that washed microbiota transplantation (WMT) is safe and effective for treating patients with nonerosive reflux disease (NERD) and proton pump inhibitor (PPI) dependency compared with PPI treatment. WMT significantly relieved the symptoms of NERD in patients, reduced PPI dependency, prolonged the duration of symptom remission, and reduced symptom recurrence.
