Intestinal microflora is important in the pathogenesis of inflammatory bowel disease (IBD).
The impact of its spatial organization on health and disease is unknown.
Dr Alexander Swidsinski and colleagues from Germany investigated sections of paraffin-embedded punched fecal cylinders.
Fluctuations in spatial distribution of 11 bacterial groups were monitored in 32 healthy subjects.
The researchers also followed 204 patients with inflammatory bowel disease, and 186 with other gastrointestinal diseases using fluorescence in situ hybridization.
|Sensitivity in patients with IBD in 12 months remission was 72%|
|Inflammatory Bowel Diseases|
The microbial structure differed in patients with Crohn's disease, ulcerative colitis, and healthy and disease controls.
The team noted that the profiles of Crohn's disease and ulcerative colitis were distinctly opposite in 6 of 11 fluorescence in situ hybridization probes used.
Most prominent were a depletion of Fecalibacterium prausnitzii (Fprau) with a normal leukocyte count in Crohn's disease.
The researchers observed a massive increase of leukocytes in the fecal-mucus transition zone with high Fprau in patients with ulcerative colitis.
The team found that these 2 features alone enabled the recognition of active Crohn's disease or ulcerative colitis with 80% sensitivity and 100% specificity.
The researchers noted that the mismatch in the sensitivity was mainly due to overlap between single inflammatory bowel disease entities.
The specificity was exclusively due to the similarity of Crohn's and celiac disease.
When inflammatory bowel disease patients were pooled the sensitivity was 100% for severe disease, and 84% for moderate activity.
The team observed that the sensitivity for inflammatory bowel disease with 12 months remission was 72%.The research team found that the sensitivity for inflammatory bowel disease with more than 12 months remission was 24%.
Dr Swidsinski's team concluded, "The fecal flora is highly structured and spatially organized."
"Diagnosing inflammatory bowel disease and monitoring disease activity can be performed based on analysis of punched fecal cylinders independent from the patient's complaints."