Fecal diversion and recurrence with high-risk microbiota

What is known

• Fecal stream diversion prevents recurrence in the neoterminal ileum, and restoring intestinal transit reproduces the lesions, establishing luminal contents as the driver. ^1,2
• A dysbiotic microbiota. Reduced alpha diversity, loss of Firmicutes/SCFA producers, enrichment of pro-inflammatory Proteobacteria. Is associated with and often precedes endoscopic postoperative recurrence. ³
• Studies on gut-microbiota signatures in postoperative recurrence have not been consistent, though some predictive taxa identified at time of surgery have emerged. ³

What is unknown / caveats

• Diversion/luminal-content data support a microbiota-mediated mechanism, but no retrieved study links diversion benefit to a defined high-risk microbiota profile
• No retrieved study stratifies diversion outcomes by microbiota profile
• Diversion evidence here concerns neoterminal-ileum recurrence and perianal/colonic disease, not microbiota-guided patient selection
• The two literatures, fecal diversion and predictive microbiota, are not connected by any interventional study in the retrieved excerpts.

References

1. Rutgeerts P, Goboes K, Peeters M, Hiele M, Penninckx F, Aerts R, Kerremans R, Vantrappen G. Effect of faecal stream diversion on recurrence of Crohn's disease in the neoterminal ileum. Lancet. 1991. PMID: 1681159.

2. Kellil T, Chaouch MA, Guedich A, Touir W, Dziri C, Zouari K. Surgical features to reduce anastomotic recurrence of Crohn's disease that requires reoperation: a systematic review. Surg Today. 2022;52(4):542-549. PMID: 34420112.

3. Sokol H, Brot L, Stefanescu C, Auzolle C, Barnich N, Buisson A, Fumery M, Pariente B, Le Bourhis L, Treton X, Nancey S, Allez M, Seksik P, REMIND Study Group I. Prominence of ileal mucosa-associated microbiota to predict postoperative endoscopic recurrence in Crohn's disease. Gut. 2020;69(3):462-472. PMID: 31142586.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.