Traditional Chinese and Western multidisciplinary team approach for gut microbiome recovery postintestinal stoma closure

Abstract

BACKGROUND

Intestinal stoma closure can lead to severe gut microbiome dysbiosis, adversely affecting postoperative recovery and quality of life. An integrative approach combining traditional Chinese medicine (TCM) and Western medicine within a multi-disciplinary team (MDT) framework presents a promising strategy to enhance gut health. However, its efficacy has not been systematically evaluated.

AIM

To investigate the efficacy of an MDT approach combining TCM and Western medicine in promoting gut microbiome recovery after intestinal stoma closure.

METHODS

A retrospective study design was employed, analyzing data from patients who underwent intestinal stoma closure between January 2020 and December 2023. Patients were divided into two groups: The control group, which received standard Western medical care, and the MDT group, which received an integrative approach combining TCM and Western medicine. Medical records were reviewed to collect data on patient demographics, clinical characteristics, pre- and postoperative gut microbiome analysis, gastrointestinal symptoms, hospital stay duration, psychological assessments, immunological indicators, and nutritional status.

RESULTS

The study included 251 patients, with 122 in the control group and 129 in the MDT group. Baseline characteristics were similar between the groups. The MDT group showed significantly higher alpha diversity (Shannon index) postoperatively compared with the control group. The MDT group had higher operational taxonomic unit counts for Bacteroidetes and Proteobacteria than the control group, whereas the control group had higher operational taxonomic unit counts for Firmicutes than the MDT group. The MDT group demonstrated lower prevalence rates of abdominal pain, bloating, and diarrhea postoperatively and shorter hospital stays than the control group. Patients in the MDT group reported improvements in chronic condition management, psychological well-being, immunological indicators, and nutritional status. The MDT group exhibited enhanced immune function, improved intestinal permeability, and better quality of life than the control group.

CONCLUSION

This retrospective study suggests that the MDT approach, combining TCM and Western medicine, has the potential to promote gut microbiome recovery and improve overall outcomes after intestinal stoma closure.

Key Words: Intestinal stoma closure; Gut microbiome recovery; Traditional Chinese medicine; Western medicine; Multidisciplinary team

Core Tip: This retrospective study demonstrates that a multi-disciplinary team approach integrating Traditional Chinese medicine with standard Western medicine significantly enhances gut microbiome recovery after intestinal stoma closure. Compared to standard care, the multi-disciplinary team approach improved microbial diversity, reduced gastrointestinal symptoms, shortened hospital stays, and enhanced immunological, nutritional, and psychological outcomes. These findings highlight the potential of integrative medicine to offer a more holistic and effective strategy for improving postoperative recovery in this patient population, providing a novel direction for clinical practice.

INTRODUCTION

Intestinal stoma closure is a critical surgical intervention performed to reverse the diversion of intestinal contents following procedures, such as ileostomy or colostomy[1]. This closure is necessary for patients to regain normal bowel function and resume a conventional lifestyle[2]. However, this surgical procedure can have crucial implications for the gut microbiome, the complex ecosystem of microorganisms residing in the gastrointestinal tract[3]. The gut microbiome plays a pivotal role in maintaining digestive health, modulating immune responses, and influencing mental well-being[4]. Disturbances to this delicate balance can lead to a range of gastrointestinal symptoms, such as abdominal pain, bloating, and diarrhea, which can impair quality of life and slow recovery[5]. The core challenges following stoma closure extend beyond transient symptoms, often involving persistent gut dysbiosis that conventional Western medical interventions struggle to address fully. Standard postoperative care typically focuses on surgical site healing, pain management, and preventing infection, with little emphasis on actively restoring the microbial ecosystem. While interventions, like probiotics, are used, their efficacy can be inconsistent and may be insufficient to correct the profound alterations caused by surgery. This situation highlights a major limitation in current management protocols, creating a clear research gap for effective and holistic strategies.

Traditional Chinese medicine (TCM), with its rich history and diverse therapeutic modalities, has been increasingly recognized for its potential to affect the gut microbiota positively[6-8]. TCM interventions, including herbal medicine, acupuncture, and dietary therapy, have been shown to have anti-inflammatory and regulatory effects that could be beneficial in restoring gut health after surgery[9]. The multi-disciplinary team (MDT) approach involves collaboration between experts in TCM and Western medicine, each bringing unique diagnostic tools and treatment strategies to the table[10]. By combining TCM’s holistic and individualized assessments with Western medicine’s advanced diagnostic technologies, MDT aims to provide a comprehensive and personalized treatment plan for each patient[11]. This integrative strategy includes TCM interventions, such as herbal formulas tailored to the patient’s specific constitution and symptoms, alongside conventional Western medical treatments, such as medications and dietary advice. This retrospective study was designed to explore the synergistic effects of integrating TCM with Western medical practices within a MDT framework to enhance gut microbiome recovery following intestinal stoma closure.

MATERIALS AND METHODS

Study design

A retrospective study was conducted to evaluate the efficacy of a combined TCM and Western medicine MDT approach in promoting gut microbiome recovery after intestinal stoma closure. The study included patients who underwent intestinal stoma closure between January 2020 and December 2023 at Shijiazhuang People’s Hospital. The patients were divided into two groups: A control group receiving standard Western medical care and an MDT group receiving an integrative MDT approach that combines TCM and Western medicine.

Study population

The study population consisted of 251 patients who underwent intestinal stoma closure between January 2020 and December 2023 at Shijiazhuang People’s Hospital. The patients were divided into two groups on the basis of their treatment approach: The control (n = 122) and MDT (n = 129) groups.

Inclusion criteria: (1) Patients aged > 18 years; (2) Patients who underwent intestinal stoma closure surgery during the study period; (3) Patients with a complete set of medical records available for review; and (4) Patients who provided informed consent for their medical data to be used in this retrospective study.

Exclusion criteria: (1) Patients with advanced cancer, severe liver or kidney dysfunction, or other systemic diseases; (2) Patients who had previous major abdominal surgery that could affect the results of the current study; (3) Patients with a history of allergic reactions to TCM herbs or other components of the integrative treatment protocol; and (4) Patients who were lost to follow-up or whose data were incomplete for analysis.

Data collection

Medical records were reviewed to collect data on patient demographics [age, gender, and body mass index (BMI)]; clinical characteristics (stoma type, stoma duration, previous surgery count, and chronic conditions); and pre- and postoperative gut microbiome composition, diversity, and functionality. Gut microbiome analysis was performed by using 16S ribosomal ribonucleic acid gene sequencing. Additionally, data on gastrointestinal symptoms, hospital stay duration, psychological well-being, and immunological and nutritional status indicators were collected.

MDT approach

Experts in TCM and Western medicine collaborated during the diagnostic phase, merging TCM's comprehensive evaluations (inspection, auscultation, inquiry, and palpation) with Western medicine’s sophisticated diagnostic tools to achieve precise diagnoses. A unified treatment strategy was developed, incorporating TCM treatments and moxibustion with Western medical interventions, such as medications and surgery, customized to the specific needs of each patient. Throughout the treatment journey, regular consultations between TCM and Western medicine practitioners occurred, enabling timely modifications to the treatment plan in response to the patient’s feedback and progress. A holistic rehabilitation program, which involved TCM’s health maintenance techniques along with Western medical rehabilitation exercises to aid in recovery and deter recurrence, was devised following treatment. TCM and Western medicine practitioners were also involved in health education, providing insights into maintaining well-being and preventing illness, thereby equipping patients with effective self-care tactics.

Treatment protocol

The control group received standard Western medical care, which included: (1) Postoperative medications, such as prophylactic antibiotics as needed, analgesics for pain management, and antiemetics for nausea; (2) Standard dietary advice, involving a gradual progression from clear liquids to a soft, low-residue diet to support healing; and (3) Physical therapy to aid in mobility and strength restoration as deemed necessary by the primary care team. By contrast, the MDT group received an integrative treatment approach that combined the above standard Western medical care with personalized TCM interventions. These interventions were formulated by a certified TCM practitioner within the MDT and included the following: (1) Herbal medicine: Patients were prescribed a modified version of the Jian Pi Li Chang Decoction (Spleen-Strengthening and Intestine-Regulating Decoction), administered orally once daily. The formula was tailored to each patient’s specific TCM pattern diagnosis (e.g., Spleen Qi Deficiency and Damp Heat in the Large Intestine) and aimed to reduce inflammation, promote gut motility, and restore digestive function; (2) Acupuncture and moxibustion: Daily sessions of acupuncture were performed at key acupoints known to regulate gastrointestinal function. These acupoints included Zusanli (ST36), Tianshu (ST25), and Shangjuxu (ST37). Moxibustion was applied to enhance warming and tonifying effects; and (3) TCM dietary therapy: In addition to standard dietary advice, patients received personalized guidance based on TCM principles, such as consuming warm, cooked foods (e.g., congee and steamed vegetables) and avoiding cold, raw, or greasy foods to protect the Spleen and Stomach qi.

Statistical analysis

Statistical analysis was performed by using SPSS software (Version 26.0). For continuous variables, data were presented as mean ± SD. Differences between the two groups were evaluated by using the independent samples t-test for normally distributed data and the Mann-Whitney U test for nonnormally distributed data. For categorical variables, frequencies, n (%) were presented, and associations were compared by using the χ² test. For gut microbiome analysis, alpha diversity was calculated by employing the Shannon index, and beta diversity was analyzed through principal coordinates analysis. Statistical significance was set at P < 0.05.

RESULTS

Patient characteristics

A total of 251 patients participated in the study, with 122 patients and 129 patients allocated to the control and MDT groups, respectively. Upon comparison, no statistically significant differences were observed between the two study groups in terms of demographic profiles and health-related factors (Table 1).

Table 1 Baseline characteristics of patients in the control and multi-disciplinary team groups, n (%).

Baseline characteristics	Control group (n = 122)	MDT group (n = 129)	P value
Age (years), mean ± SD	55.2 ± 10.1	54.9 ± 9.8	0.723
Gender			0.845
Male	67 (55.0)	68 (52.7)
Female	55 (45.0)	61 (47.3)
BMI (kg/m²), mean ± SD	23.4 ± 3.1	23.6 ± 3.0	0.652
Duration of stoma (months), mean ± SD	8.5 ± 2.6	8.4 ± 2.5	0.876
Type of stoma			0.789
Ileostomy	72 (58.9)	75 (58.1)
Colostomy	50 (41.1)	54 (41.9)
Previous surgery count, mean ± SD	1.2 ± 0.4	1.3 ± 0.5	0.462
Chronic conditions			0.521
DM	17 (13.9)	16 (12.4)
HTN	15 (12.3)	15 (11.6)
Asthma	11 (9.0)	13 (10.1)
CKD	9 (7.4)	8 (6.2)
Heart disease	7 (5.7)	8 (6.2)	0.371
Preoperative Gut Symptom Score, mean ± SD	6.2 ± 1.5	6.3 ± 1.4	0.425
Psychological State Score, mean ± SD	3.1 ± 0.8	3.0 ± 0.7	0.538
Gut microbiome diversity, mean ± SD	3.5 ± 0.6	3.6 ± 0.5
Gut microbiome function, mean ± SD	2.8 ± 0.7	2.9 ± 0.6		0.614

BMI: Body mass index; DM: Diabetes mellitus; HTN: Hypertension; CKD: Chronic kidney disease; MDT: Multi-disciplinary team.

Gut microbiome composition and diversity

As shown in Figure 1, the MDT group showed a significantly higher alpha diversity postoperatively than the control group (P < 0.05). Furthermore, gut microbiome analysis revealed significant compositional differences (Table 2). The MDT group had higher operational taxonomic unit counts for Bacteroidetes and Proteobacteria than the control group (all P < 0.05), whereas the control group showed higher operational taxonomic unit counts for Firmicutes than the MDT group (P < 0.05).

Figure 1 The graph illustrates the difference in alpha diversity between the control and multi-disciplinary team groups. ^aP < 0.05, control vs multi-disciplinary team. MDT: Multi-disciplinary team.

Table 2 Comparative analysis of gut microbiome operational taxonomic unit counts between groups.

Gut microbiome characteristics	Control group (n = 122)	MDT group (n = 129)	P value
OTUs of Bacteroidetes	1.2 × 108 ± 5.0 × 107	1.4 × 108 ± 4.8 × 107	0.001
OTUs of Firmicutes	1.8 × 108 ± 6.3 × 107	1.7 × 108 ± 5.9 × 107	0.033
OTUs of Proteobacteria	6.1 × 107 ± 4.1 × 106	7.3 × 107 ± 3.7 × 106	< 0.001

OTUs: Operational taxonomic units; MDT: Multi-disciplinary team.

Gastrointestinal symptoms and recovery

As detailed in Table 3, the MDT group demonstrated a significantly lower prevalence of abdominal pain, bloating, and diarrhea postoperatively than the control group (all P < 0.05). Additionally, the MDT group had a shorter hospital stay, with 58.9% of its patients discharged within five days, than the control group, with 36.9% of its patients discharged within five days (P = 0.002).

Table 3 Gastrointestinal symptoms and postoperative hospital stay in control and multi-disciplinary team groups, n (%).

Outcome measure	Control group (n = 122)	MDT group (n = 129)	P value
Number of patients reporting
Abdominal pain	38 (31.1)	20 (15.5)	0.003
Bloating	52 (42.6)	30 (23.3)	0.001
Diarrhea	29 (23.8)	12 (9.3)	0.014
Constipation	15 (12.3)	5 (3.9)	0.032
Postoperative hospital stay (days)
≤ 5 days	45 (36.9)	76 (58.9)	0.002
> 5 days	77 (63.1)	53 (41.1)	0.002

MDT: Multi-disciplinary team.

Effect on chronic conditions

The integrative MDT approach also appeared beneficial in managing chronic conditions (Table 4). The MDT group experienced a significantly higher rate of medication reduction for diabetes mellitus, hypertension, and chronic kidney disease postoperatively compared with the control group (all P < 0.05).

Table 4 Impact of the multi-disciplinary team approach on chronic condition management, n (%).

Chronic condition management	Control group (n = 122)	MDT group (n = 129)	P value
Medication reduction for DM	10 (8.2)	22 (17.1)	0.011
Medication reduction for HTN	12 (9.8)	25 (19.4)	0.019
Medication reduction for CKD	7 (5.7)	16 (12.4)	0.027

DM: Diabetes mellitus; HTN: Hypertension; CKD: Chronic kidney disease; MDT: Multi-disciplinary team.

Psychological well-being

As illustrated in Figure 2, the patients in the MDT group reported better psychological well-being, with a significant reduction in depression (Figure 2A) and anxiety (Figure 2B) scores compared with the control group (all P < 0.05).

Figure 2 Psychological well-being scores in control and multi-disciplinary team groups. ^aP < 0.05, control vs multi-disciplinary team. The Generalized Anxiety Disorder 7-item scale was used to assess anxiety and the Patient Health Questionnaire-9 for depression was used to assess depression. A: Depression score reduction; B: Anxiety score reduction. MDT: Multi-disciplinary team.

Immunological indicators

Figure 3 presents a comparison of key immunological indicators. The results showed that the MDT group had significantly higher levels of albumin, total protein, transferrin, and prealbumin compared with the control group (all P < 0.05), suggesting an improved immunological and nutritional status.

Figure 3 Comparison of immunological indicators between multi-disciplinary team and control group. ^aP < 0.05, control vs multi-disciplinary team. A: Albumin level; B: Total protein; C: Prealbumin; D: Transferrin. MDT: Multi-disciplinary team.

Nutritional status

The MDT group demonstrated significant improvements in nutritional status across multiple markers, as shown in Table 5. These improvements included a small negative change in BMI; reduced malnutrition prevalence; and significantly increased serum levels of sodium, potassium, calcium, vitamin B12, and vitamin D (all P < 0.05). Moreover, daily caloric, protein, and fiber intakes were notably higher in the MDT group than in the control group (all P < 0.05).

Table 5 Nutritional status indicators between control and multi-disciplinary team groups.

Nutritional status indicators	Control group (n = 122)	MDT group (n = 129)	P value
BMI change	-1.2 ± 0.4	-0.8 ± 0.3	0.009
Malnutrition prevalence	27 (22.1)	12 (9.3)	0.016
Serum sodium (mmol/L)	135 ± 3	137 ± 2	0.012
Serum potassium (mmol/L)	3.9 ± 0.4	4.1 ± 0.3	0.028
Serum calcium (mg/dL)	8.7 ± 0.6	9.0 ± 0.5	0.031
Vitamin B12 (pg/mL)	200 ± 40	220 ± 35	0.036
Vitamin D (ng/mL)	20 ± 5	25 ± 4	0.019
Daily caloric intake (kcal)	1800 ± 200	2000 ± 150	0.026
Protein intake (g/day)	60 ± 10	65 ± 8	0.017
Fiber intake (g/day)	20 ± 5	25 ± 4	0.024

BMI: Body mass index; MDT: Multi-disciplinary team.

Outcome measures

The MDT group exhibited enhanced immune function, as detailed in Figure 4. This enhancement was evidenced by the significantly increased percentages of CD4+ (Figure 4A), CD8+ (Figure 4B), and regulatory (Figure 4C) T cells, indicating a robust and balanced immune response (all P < 0.05).

Figure 4 Detailed outcome measures of immune function. ^aP < 0.05, control vs multi-disciplinary team. A: CD4+ T cells; B: CD8+ T cells; C: Regulatory T cells. MDT: Multi-disciplinary team.

Intestinal permeability and quality of life

Finally, as illustrated in Table 6, the MDT group experienced significant improvements in intestinal permeability, as reflected by a reduced lactulose: Mannitol ratio (P < 0.05). This change was accompanied with notable enhancements in quality of life, with the MDT group scoring higher in physical functioning, mental health, and social functioning compared with the control group (all P < 0.05).

Table 6 Intestinal permeability and quality of life in control and multi-disciplinary team groups, mean ± SD.

Outcome measures	Control group (n = 122)	MDT group (n = 129)	P value
Intestinal permeability - lactulose/mannitol ratio	0.12 ± 0.03	0.09 ± 0.02	0.015
Quality of life - physical functioning (SF-36)	68.9 ± 8.4	77.5 ± 7.3	0.022
Quality of life - mental health (SF-36)	62.1 ± 9.2	70.4 ± 8.6	0.031
Quality of life - social functioning (SF-36)	73.2 ± 10.1	81.5 ± 9.4	0.029

SF-36: 36-Item Short Form Health Survey; MDT: Multi-disciplinary team.

DISCUSSION

In recent years, integrative medicine has gained remarkable traction within the healthcare community as healthcare providers increasingly recognize the synergistic advantages of blending traditional and complementary therapeutic strategies with conventional Western medical interventions[12-14]. At the heart of this integrative approach lies the MDT methodology, which leverages the collective expertise of professionals from diverse medical specialties to provide comprehensive and patient-centric care[15]. The gut microbiome, a complex ecosystem of microorganisms residing within the gastrointestinal tract, has emerged as a critical factor influencing digestion, immunity, and mental health[16]. Disruptions to this delicate microbial equilibrium can lead to a wide range of gastrointestinal symptoms and broad health issues, highlighting the pivotal role of restoring the gut microbiome as a key component of postoperative recovery following intestinal stoma reversal procedures[17].

The results of this retrospective study indicate that the MDT approach, which combines TCM and Western medicine, has the potential to promote gut microbiome recovery effectively following intestinal stoma closure. This integrative strategy not only improved the composition, diversity, and functionality of the gut microbiome but also resulted in a reduction in gastrointestinal symptoms and a shortened hospital stay. The improvement in gut microbiome diversity, as evidenced by the higher Shannon index in the MDT group than in the control group, is particularly encouraging. This increased diversity may reflect a healthy gut ecosystem, which is crucial for the maintenance of overall health. The gut microbiome plays a pivotal role in various physiological processes, including digestion, metabolism, immune function, and even mental health[18-20]. Therefore, the positive changes observed in the MDT group could have wide-ranging implications for the well-being of patients after intestinal stoma closure. The gut microbiome analysis also revealed significant differences in the abundance of certain bacterial taxa between the two groups. The MDT group exhibited higher counts of Bacteroidetes and Proteobacteria compared with the control group, whereas the control group had higher counts of Firmicutes compared with the MDT group. These differences suggest that the integrative approach may influence the gut microbiome in a way that promotes a balanced and resilient microbial community. This balance is important because dysbiosis, or an imbalance in the gut microbiota, has been associated with various health issues, including gastrointestinal disorders, metabolic diseases, and immune dysregulation[21].

The reduction in gastrointestinal symptoms in the MDT group is another key finding. Abdominal pain, bloating, and diarrhea are common postoperative complications following intestinal stoma closure[22]. The fact that the MDT group experienced fewer of these symptoms relative to the control group suggests that the integrative approach may help mitigate the postoperative impact on the gut microbiome and improve digestive function. This effect could be due to the anti-inflammatory and regulatory effects of TCM interventions, which may help restore gut health and reduce inflammation. The shortened hospital stays in the MDT group are an additional benefit of the integrative approach. This finding not only improves patient satisfaction but also has economic implications by reducing healthcare costs. The reasons for the shortened stays are likely multifactorial, including reduced gastrointestinal symptoms, improved gut barrier function, and enhanced overall recovery. These factors may contribute to a rapid return to normal activities and an improved quality of life for patients.

The MDT approach also had a positive influence on chronic condition management. Patients with chronic conditions, such as diabetes mellitus, hypertension, and chronic kidney disease, reported improvements in their condition management postoperatively. This situation suggests that the integrative approach may offer additional benefits beyond gut health, potentially because of the holistic nature of TCM, which aims to treat the whole person rather than just the symptoms of a disease. The improved psychological well-being in the MDT group is another important finding. Postoperative anxiety and depression are common among patients undergoing intestinal stoma closure, and the integrative approach appears to offer remarkable benefits in this regard[23]. The reasons for this improvement might be related to the supportive and holistic nature of TCM, which addresses not only physical symptoms but also emotional and mental well-being. The immunological indicators in the MDT group also significantly improved, with increased levels of albumin, total protein, transferrin, and prealbumin. These findings suggest that the integrative approach may have a positive effect on the immune system, which is important for postoperative recovery and overall health. A robust immune system can help prevent infections and other complications, leading to a fast and complete recovery[24].

The nutritional status improvements in the MDT group are another noteworthy finding. The reductions in BMI change and malnutrition prevalence, as well as the increased levels of key serum markers and dietary intake, indicate that the integrative approach may help improve nutrient absorption and utilization, which is crucial for recovery and overall health. Proper nutrition is essential for wound healing, immune function, and energy production, and the findings suggest that the integrative approach may offer considerable benefits in this regard[25]. The enhanced immune function in the MDT group, as evidenced by the increased percentages of CD4+, CD8+, and regulatory T cells, is particularly encouraging. These cells are critical for maintaining a balanced immune response, and their high levels in the MDT group suggest that the integrative approach may help improve immune function, which is important for postoperative recovery and overall health. A robust immune system can help prevent infections and other complications, leading to rapid and complete recovery[26]. The improvements in intestinal permeability and quality of life in the MDT group are also important findings. The reduced lactulose: Mannitol ratio in the MDT group suggests improved gut barrier function, which is crucial for preventing the entry of harmful substances into the bloodstream. The enhanced quality of life, particularly in physical functioning, mental health, and social functioning, as measured by the SF-36 scale, with the MDT group demonstrating better outcomes than the control group, indicates that the integrative approach may offer considerable benefits in this regard.

While the results of this study are promising, acknowledging the limitations of its retrospective design is important. The retrospective nature of this work may introduce selection bias, and the findings may not be generalizable to all patient populations. Furthermore, this study relied on medical records, which may be incomplete or inaccurate, for data collection. Future research should aim to validate these findings in large, prospective studies with rigorous methodology and standardized data collection

CONCLUSION

This study demonstrates the potential benefits of a combined TCM and Western MDT approach in promoting gut microbiome recovery and overall health following intestinal stoma closure. This integrative strategy not only improved the composition, diversity, and functionality of the gut microbiome but also resulted in a reduction in gastrointestinal symptoms, shortened hospital stays, and improved recovery outcomes. Its findings suggest that the MDT approach offers a promising strategy for optimizing postoperative recovery and improving patient outcomes in this patient population.