J Neurogastroenterol Motil.
2024 Jul;30(3):332-342. 10.5056/jnm22191.
Impact of Esophageal Motility on Microbiome Alterations in Symptomatic Gastroesophageal Reflux Disease Patients With Negative Endoscopy: Exploring the Role of Ineffective Esophageal Motility and Contraction Reserve
- Affiliations
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- 1Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
- 2School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
- 3Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- 4Departments of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
- 5Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- 6Department of Life Sciences, Tzu Chi University, Hualien, Taiwan
- 7Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- 8Division of Gastroenterology, Washington University School of Medicine, St Louis, MI, USA
- 9Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- KMID: 2557970
- DOI: http://doi.org/10.5056/jnm22191
Abstract
- Background/Aims
Ineffective esophageal motility (IEM) is common in patients with gastroesophageal reflux disease (GERD) and can be associated with poor esophageal contraction reserve on multiple rapid swallows. Alterations in the esophageal microbiome have been reported in GERD, but the relationship to presence or absence of contraction reserve in IEM patients has not been evaluated. We aim to investigate whether contraction reserve influences esophageal microbiome alterations in patients with GERD and IEM.
Methods
We prospectively enrolled GERD patients with normal endoscopy and evaluated esophageal motility and contraction reserve with multiple rapid swallows during high-resolution manometry. The esophageal mucosa was biopsied for DNA extraction and 16S ribosomal RNA gene V3-V4 (Illumina)/full-length (Pacbio) amplicon sequencing analysis.
Results
Among the 56 recruited patients, 20 had normal motility (NM), 19 had IEM with contraction reserve (IEM-R), and 17 had IEM without contraction reserve (IEM-NR). Esophageal microbiome analysis showed a significant decrease in microbial richness in patients with IEM-NR when compared to NM. The beta diversity revealed different microbiome profiles between patients with NM or IEM-R and IEM-NR (P = 0.037). Several esophageal bacterial taxa were characteristic in patients with IEM-NR, including reduced Prevotella spp. and Veillonella dispar, and enriched Fusobacterium nucleatum. In a microbiome-based random forest model for predicting IEM-NR, an area under the receiver operating characteristic curve of 0.81 was yielded.
Conclusions
In symptomatic GERD patients with normal endoscopic findings, the esophageal microbiome differs based on contraction reserve among IEM. Absent contraction reserve appears to alter the physiology and microbiota of the esophagus.
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