ArticleGastroenterology2021
Mucosal Biofilms Are an Endoscopic Feature of Irritable Bowel Syndrome and Ulcerative Colitis.
Article in Gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 79 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
79 citing papers in PubMed, 2 syntheses or guidelines pooled it, 128 citations in OpenAlex.
- Symptomatic Response to Antibiotics in Patients With Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-analysis.Journal of neurogastroenterology and motility · 2024Pooled it
- Safety and efficacy of fecal microbiota transplantation for autoimmune diseases and autoinflammatory diseases: A systematic review and meta-analysis.Frontiers in immunology · 2022Pooled it
- Gut microbiota signatures in tissues of the colorectal polyp and normal colorectal mucosa, and faeces.Frontiers in cellular and infection microbiology · 2022Trial
- Role of Bile Acid Receptors in Non-Infectious Diarrhea: A Narrative Review.Medical science monitor : international medical journal of experimental and clinical research · 2026Review
- Irritable bowel syndrome.Nature reviews. Disease primers · 2026Review
- Article
- Viable and Heat-InactivatedMicroorganisms · 2026Article
- FMT from IBS-D Rats Impairs Intestinal Barrier Function and is Associated with Increased Intestinal Benzoic Acid andJournal of microbiology and biotechnology · 2026Article
- Gut Microbiota in Irritable Bowel Syndrome and Inflammatory Bowel Disease: Differences in Pathophysiology, Biomarkers, and Treatment Implications.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Abdominal Pain After Bariatric Surgery and the Role of the Gut: A Review.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2026Review
- A genetic toolkit for the human gut bacterium Mediterraneibacter gnavus identifies capsular polysaccharides as a competitive colonization factor.Nature communications · 2026Article
- Response to Kårhus et al. Regarding "Gastro hep advances · 2026Article
- Farnesol, the farnesol pathway, and the immune-gut-brain axis.Frontiers in pharmacology · 2026Review
- Short-chain fatty acids in ulcerative colitis: integrating metabolic fate, dynamic biomarkers, and precision delivery.Frontiers in nutrition · 2026Review
- A microbiota-derived bile acid modulates biofilm formation by the probiotic strain Escherichia coli Nissle 1917.NPJ biofilms and microbiomes · 2025Article
- Ileal Biofilms Confirm SIBO-IBS Hypothesis: Comment on PMID 38798120.Neurogastroenterology and motility · 2025Article
- Epidemiology of bacterial biofilms on polyps and normal tissues in a screening colonoscopy cohort.Gut microbes · 2025Observational
- The global stress response regulatorGut microbes · 2025Article
- Gut microbiota signature in a cohort of Chinese patients with rosacea.Biochemistry and biophysics reports · 2025Article
- Article
19 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
25 authors at 4 institutions in 2 countries.
Funding
Abstract
BACKGROUND &
aimsIrritable bowel syndrome (IBS) and inflammatory bowel diseases result in a substantial reduction in quality of life and a considerable socioeconomic impact. In IBS, diagnosis and treatment options are limited, but evidence for involvement of the gut microbiome in disease pathophysiology is emerging. Here we analyzed the prevalence of endoscopically visible mucosal biofilms in gastrointestinal disease and associated changes in microbiome composition and metabolism.
methodsThe presence of mucosal biofilms was assessed in 1426 patients at 2 European university-based endoscopy centers. One-hundred and seventeen patients were selected for in-depth molecular and microscopic analysis using 16S ribosomal RNA gene amplicon-sequencing of colonic biopsies and fecal samples, confocal microscopy with deep learning-based image analysis, scanning electron microscopy, metabolomics, and in vitro biofilm formation assays.
resultsBiofilms were present in 57% of patients with IBS and 34% of patients with ulcerative colitis compared with 6% of controls (P < .001). These yellow-green adherent layers of the ileum and right-sided colon were microscopically confirmed to be dense bacterial biofilms. 16S-sequencing links the presence of biofilms to a dysbiotic gut microbiome, including overgrowth of Escherichia coli and Ruminococcus gnavus. R. gnavus isolates cultivated from patient biofilms also formed biofilms in vitro. Metabolomic analysis found an accumulation of bile acids within biofilms that correlated with fecal bile acid excretion, linking this phenotype with a mechanism of diarrhea.
conclusionsThe presence of mucosal biofilms is an endoscopic feature in a subgroup of IBS and ulcerative colitis with disrupted bile acid metabolism and bacterial dysbiosis. They provide novel insight into the pathophysiology of IBS and ulcerative colitis, illustrating that biofilm can be seen as a tipping point in the development of dysbiosis and disease.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.