Fu Y. Letter to the Editor: Probiotics counteract polyethylene glycol bowel preparation dysbiosis and infection risk. World J Gastroenterol 2026; 32(28): 118993 [DOI: 10.3748/wjg.118993]
Corresponding Author of This Article
Yang Fu, PhD, Department of Gastroenterology, Institute of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 Songjiang Road, Shanghai 201600, China. yzfuyang3341@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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letter
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Fu Y. Letter to the Editor: Probiotics counteract polyethylene glycol bowel preparation dysbiosis and infection risk. World J Gastroenterol 2026; 32(28): 118993 [DOI: 10.3748/wjg.118993]
World J Gastroenterol. Jul 28, 2026; 32(28): 118993 Published online Jul 28, 2026. doi: 10.3748/wjg.118993
Letter to the Editor: Probiotics counteract polyethylene glycol bowel preparation dysbiosis and infection risk
Yang Fu
Yang Fu, Department of Gastroenterology, Institute of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
Author contributions: Fu Y designed the overall concept and outline of the manuscript, performed the literature review drafted, revised, and edited the manuscript.
Supported by the National Natural Science Foundation of China, No. 82300731.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Yang Fu, PhD, Department of Gastroenterology, Institute of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 Songjiang Road, Shanghai 201600, China. yzfuyang3341@163.com
Received: January 16, 2026 Revised: January 28, 2026 Accepted: March 2, 2026 Published online: July 28, 2026 Processing time: 174 Days and 16.1 Hours
Abstract
Polyethylene glycol (PEG) bowel preparation, though widely used, can significantly disrupt gut microbiota composition. Kou et al recently published study in the World Journal of Gastroenterology, which demonstrated that PEG-treated mice challenged with Citrobacter rodentium exhibit higher pathogen loads, elevated virulence gene expression, and worsened colitis, mediated by microbiota dysbiosis. Importantly, Lactobacillus acidophilus supplementation restored microbial balance and mitigated infection severity, suggesting PEG-induced loss of colonization resistance exposes a 14-day infection window. This paradigm aligns with a rare human case of septic shock after PEG bowel preparation, highlighting potential opportunistic infection risk. Probiotic Lactobacillus strengthen the epithelial barrier and modulate immunity, and clinical trials support their efficacy and safety in gastrointestinal contexts. We discuss the translational significance of these findings and advocate microbiota-protective strategies (probiotic supplementation, optimal timing of endoscopy, and dietary adjustments) during bowel preparation.
Core Tip: Polyethylene glycol bowel preparation can transiently disrupt gut microbiota and weaken colonization resistance, potentially increasing susceptibility to enteric infections. Kou et al provide mechanistic evidence that polyethylene glycol creates a 14-day vulnerability window in which Citrobacter rodentium colonization, virulence, and colitis severity are amplified in a microbiota-dependent manner. Importantly, Lactobacillus acidophilus supplementation restores microbial balance and reduces infection severity, supporting microbiota-protective strategies. These findings, together with real-world data showing non-negligible post-colonoscopy infection visits, argue for risk stratification and microbiota-sparing adjuncts in high-risk patients.
