Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease

doi:10.3748/wjg.v27.i6.513

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World Journal of Gastroenterology

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Retrospective Study

World J Gastroenterol. Feb 14, 2021; 27(6): 513-522
Published online Feb 14, 2021. doi: 10.3748/wjg.v27.i6.513

Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease

Ya-Mei Zheng, Xian-Yun Chen, Jie-Yi Cai, Yu Yuan, Wen-Rui Xie, Jia-Ting Xu, Harry Hua-Xiang Xia, Min Zhang, Xing-Xiang He, Li-Hao Wu

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.

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
Processing time: 67 Days and 23.6 Hours

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.

Keywords: Nonerosive reflux disease; Washed microbiota transplantation; Proton pump inhibitor dependency; Intestinal bacteria; Lipopolysaccharide; Small intestinal bacterial overgrowth

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.