Faecal Microbiota in Patients with Neurogenic Bowel Dysfunction and Spinal Cord Injury or Multiple Sclerosis-A Systematic Review

Willemijn Faber; Janneke Stolwijk-Swuste; Florian van Ginkel; Janneke Nachtegaal; Erwin Zoetendal; Renate Winkels; Ben Witteman

doi:10.3390/jcm10081598

Faecal Microbiota in Patients with Neurogenic Bowel Dysfunction and Spinal Cord Injury or Multiple Sclerosis-A Systematic Review

J Clin Med. 2021 Apr 9;10(8):1598. doi: 10.3390/jcm10081598.

Authors

Willemijn Faber¹, Janneke Stolwijk-Swuste², Florian van Ginkel³, Janneke Nachtegaal⁴, Erwin Zoetendal⁵, Renate Winkels⁶, Ben Witteman⁶

Affiliations

¹ Heliomare Rehabilitation Centre, 1949 EC Wijk aan Zee, The Netherlands.
² Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht University, 3583 TM Utrecht, The Netherlands.
³ Faculty of Medicine, Utrecht University, 3584 CG Utrecht, The Netherlands.
⁴ Heliomare Rehabilitation Center, Department of Research & Development, 1949 EC Wijk aan Zee, The Netherlands.
⁵ Laboratory of Microbiology, Wageningen University and Research, Wageningen University, 6708 PB Wageningen, The Netherlands.
⁶ Division of Human Nutrition and health, Wageningen University and Research, Wageningen University, 6708 PB Wageningen, The Netherlands.

Abstract

Background: Neurogenic bowel dysfunction (NBD) frequently occurs in patients with spinal cord injury (SCI) and multiple sclerosis (MS) with comparable symptoms and is often difficult to treat. It has been suggested the gut microbiota might influence the course of NBD. We systematically reviewed the literature on the composition of the gut microbiota in SCI and MS, and the possible role of neurogenic bowel function, diet and antibiotic use.

Methods: A systematic search was conducted in PubMed and Embase, which retrieved studies on the gut microbiota in SCI and MS. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess methodological quality.

Results: We retrieved fourteen papers (four on SCI, ten on MS), describing the results of a total of 479 patients. The number of patients per study varied from 13 to 89 with an average of 34. Thirteen papers were observational studies and one study was an intervention study. The studies were case control studies in which the gut microbiota composition was determined by 16S rRNA gene sequencing. The methodological quality of the studies was mostly rated to be moderate. Results of two studies suggested that alpha diversity in chronic SCI patients is lower compared to healthy controls (HC), whereas results from five studies suggest that the alpha diversity of MS patients is similar compared to healthy subjects. The taxonomic changes in MS and SCI studies are diverse. Most studies did not account for possible confounding by diet, antibiotic use and bowel function.

Conclusion: Based on these 14 papers, we cannot draw strong conclusions on the composition of the gut microbiota in SCI and MS patients. Putatively, alpha diversity in chronic SCI patients may be lower compared to healthy controls, while in MS patients, alpha diversity may be similar or lower compared to healthy controls. Future studies should provide a more detailed description of clinical characteristics of participants and of diet, antibiotic use and bowel function in order to make valid inferences on changes in gut microbiota and the possible role of diet, antibiotic use and bowel function in those changes.

Keywords: gut microbiota; multiple sclerosis; neurogenic bowel dysfunction; spinal cord injury.

Publication types

Review

Grants and funding

1234/Coloplast