The impact of washed microbiota transplantation on serum gastric function markers: Pepsinogen I, Pepsinogen II, and Gastrin-17

Abstract

Background and aims: Conventional treatment methods for gastric diseases have problems such as drug resistance and recurrence. This study aims to explore whether a new treatment method - Washed Microbiota Transplantation (WMT) - can improve gastric mucosal health. Methods: The clinical data of patients before and after WMT treatment were collected and analyzed, including serum gastric function markers: gastrin-17 (G-17), pepsinogen I (PGI), pepsinogen II (PGII), and the PGI/PGII ratio (PGR). Inflammatory biomarkers: C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). Fresh fecal samples were collected at baseline and after WMT treatment and stored at −80 ℃ until analysis. Gut microbiota profiling was performed using 16S rRNA genes sequencing. Gastrointestinal symptom severity as measured by the Gastrointestinal Symptom Rating Scale (GSRS), and health-related quality of life assessed by the SF-36 physical and mental component summaries (PCS and MCS). The safety and tolerability of WMT were also assessed. Results: After WMT treatment, serum G-17 and PGI levels decreased significantly within the WMT group (both P < 0.05), while PGII demonstrated a downward trend. Notably, in between-group comparisons, only the change in G-17 showed a statistically significant advantage over the control group (P = 0.032), whereas differences in PGI, PGII, and PGR were not significant. Inflammatory markers CRP and PCT likewise declined within the WMT group; notably, the magnitude of CRP reduction positively correlated with changes in PGI. Furthermore, 16S rRNA sequencing revealed a significant increase in gut microbial α-diversity following WMT, with Chao1, Shannon, and Simpson indices all significantly elevated after the second treatment course compared with baseline (P < 0.05); the relative abundances of several key genera were significantly altered. In addition, patients exhibited significant improvement in GSRS scores (P < 0.01), and both SF-36 PCS and MCS scores increased markedly compared to baseline (P < 0.01). No serious adverse events were observed during the study period; a minority of patients reported mild, transient bloating or diarrhea. Conclusions: WMT was associated with improvements in gastric mucosal health, gut microbial abundance and diversity, accompanied by reduced inflammation, alleviated gastrointestinal symptoms, improved quality of life, and a favorable safety profile.