Postoperative Microbiome Profiles Predict Crohn’s Disease Recurrence
A multicenter prospective study published in Clinical Gastroenterology and Hepatology has identified specific mucosa-associated microbiome changes that precede postoperative recurrence of Crohn’s disease, offering a potential new target for risk stratification and therapeutic intervention.
The study analyzed 944 biopsy samples from 262 patients with Crohn’s disease who underwent ileocolic resection and follow-up colonoscopy at 6 academic centers. Researchers performed 16S rRNA gene sequencing on samples from the neoterminal ileum, colon, and rectosigmoid to assess microbial diversity and composition. A Rutgeerts score of ≥i2 at follow-up colonoscopy defined endoscopic recurrence.
“Ileal inflammation accounted for most of the explained variance of the ileal and colonic mucosa-associated microbiota,” the authors reported. Among patients in endoscopic remission at the first postoperative colonoscopy, those who later developed recurrence at the second colonoscopy had significantly lower microbial diversity and distinct microbiota profiles compared to those who remained in remission.
Key microbial signatures included depletion of the genus Anaerostipe and an increased presence of several genera from the class Gammaproteobacteria across all 3 biopsy sites. These microbial shifts were associated with a higher risk of future recurrence.
Importantly, the gut microbiome outperformed clinical features in predicting recurrence. “Gut microbiome was able to predict future recurrence better than clinical features,” the study concluded, based on random forest modeling that integrated microbial and clinical data.
These findings support the role of mucosa-associated microbiota in the pathogenesis of Crohn’s disease recurrence and underscore the potential for microbiome-based monitoring and intervention strategies. “Targeted microbial modulation is a plausible modality to prevent postoperative Crohn’s disease recurrence,” the authors stated.
For practicing gastroenterologists, the results highlight the value of microbiome profiling after surgical remission as a predictive tool and suggest a future role for microbiota-directed therapies in postoperative disease management.
Reference
Hernández-Rocha C, Turpin W, Borowski K, et al. After surgically induced remission, ileal and colonic mucosa-associated microbiota predicts crohn's disease recurrence. Clin Gastroenterol Hepatol. 2025;23(4):612-620.e10. doi:10.1016/j.cgh.2024.06.022
