Basic Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2022; 28(8): 811-824
Published online Feb 28, 2022. doi: 10.3748/wjg.v28.i8.811
Mucosal bacterial dysbiosis in patients with nodular lymphoid hyperplasia in the terminal ileum
Qiao-Li Jiang, You Lu, Meng-Jie Zhang, Zhen-Yu Cui, Zhong-Mei Pei, Wen-Hua Li, Lun-Gen Lu, Jing-Jing Wang, Ying-Ying Lu
Qiao-Li Jiang, You Lu, Meng-Jie Zhang, Zhen-Yu Cui, Zhong-Mei Pei, Wen-Hua Li, Ying-Ying Lu, Department of Gastroenterology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201803, China
Lun-Gen Lu, Ying-Ying Lu, Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
Jing-Jing Wang, Shanghai Key Laboratory of Pancreatic Diseases, Institute of Translational Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
Author contributions: Jiang QL and Lu Y equally contributed on this manuscript, designed and conceived the experiments; Lu Y and Li WH collected patient samples and data; Jiang QL, Zhang MJ, Cui ZY and Pei ZM performed the 16S rRNA sequencing data analysis; Jiang QL and Lu YY acquired and analyzed data, wrote the manuscript; Lu YY and Wang JJ provided guidance for sample processing methodology; Lu LG reviewed the manuscript; all authors approved the final version of the article.
Supported by the Science and Technology Project of Jiading Hospital, Shanghai General Hospital, No. 202134A and No. 202125A.
Institutional review board statement: The study was reviewed and approved by the Reseach Ethics Boards of the Shanghai General Hospital (2021KY085).
Informed consent statement: The written informed consent was obtained from all the patients before sample collection.
Conflict-of-interest statement: The authors declare that they have no competing interests.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Ying Lu, PhD, Associate Chief Physician, Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 Songjiang Road, Shanghai 201620, China. le_voyageur@qq.com
Received: October 1, 2021
Peer-review started: October 1, 2021
First decision: November 7, 2021
Revised: November 19, 2021
Accepted: January 14, 2022
Article in press: January 14, 2022
Published online: February 28, 2022
Processing time: 146 Days and 9.1 Hours
Abstract
BACKGROUND

Nodular lymphoid hyperplasia (NLH) in the small intestine is a rare benign lesion characterized by multiple small nodules on the intestinal surface. Patients with terminal ileal NLH may experience long-term abdominal pain, diarrhea, and abdominal distension, among other symptoms. Supplementation with probiotics could mitigate these symptoms. NLH is linked to the immune system, and it may result from accumulation of plasma-cell precursors due to a maturational defect during the development of B lymphocytes. The intestinal microbiome plays an essential role in the immune system. Thus, we speculate that the gut flora plays a key role in terminal ileal NLH.

AIM

To explore the correlation between intestinal flora and terminal ileal NLH.

METHODS

We collected mucosal biopsy samples that were obtained via colonoscopy from 15 patients with terminal ileal NLH (the test group) and 15 normal subjects (the control group). We subsequently performed 16S-rRNA gene amplicon sequencing of these samples, and the results were evaluated using alpha diversity, beta diversity and microbial composition analyses. The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States was used to predict the metabolic pathways and orthologous groups according to the Kyoto Encyclopedia of Genes and Genomes database.

RESULTS

Compared with the control group, the terminal ileal NLH group showed an increased alpha diversity (P < 0.05). The overall intestinal microbiota in the NLH group was significantly different from that of the control group (P < 0.05), implying that there was the dysbiosis in the terminal ileal NLH patients. The relative abundance of phylum Bacteroidetes was significantly lower in the NLH group, while that of Patescibacteria and Campilobacterota was significantly higher. The genus Bacteroides was the dominant gut microbiota in both groups, but its abundance was significantly lower in the test group than it was in the control group. Conversely, the relative abundances of Haemophilus, Streptococcus, Pseudomonas, Actinomyces, TM7X, Fusobacterium nucleatum, Parvimonas, Granulicatella, Helicobacter, and the [Eubacterium] nodatum group were significantly higher in the test group than they were in the control group. In addition, several altered metabolic pathways, orthologous groups, and modules were found. For example, the Peptidoglycan biosynthesis and Aminoacyl tRNA biosynthesis were both increased in the test group.

CONCLUSION

Maintaining the microbial balance and supplementing targeted protective bacteria could improve symptoms and potentially reduce the risk of lymphoma transformation in patients with terminal ileal NLH.

Keywords: Hyperplasia; Bacteroides; Small intestine; Microbiome; Helicobacter pylori; Colonoscopy

Core Tip: Nodular lymphoid hyperplasia (NLH) in the small intestine is a rare benign lesion characterized by multiple small nodules on the surface of the intestine. To explore the correlation between the intestinal flora and terminal ileal NLH, we performed bacterial 16S rRNA gene sequencing of mucosal samples from patients with terminal ileal NLH. Our results reveal that specific microflora may act on the mucosa of the small intestine and cause terminal ileal NLH. Therefore, maintaining the balance of intestinal flora and supplementing targeted protective bacteria may improve terminal ileal NLH symptoms and potentially reduce the risk of lymphoma transformation.