Systematic Evaluation of Clinical, Nutritional and Fecal Microbial Factors for their Association with Colorectal Polyps

David Schult, H. Carlo Maurer, Marina Frolova, Marc Ringelhan, Ulrich Mayr, Jörg Ulrich, Markus Heilmaier, Sebastian Rasch, Tobias Lahmer, Sandra Reitmeier, Chiara Hennig, Christina Gassner, Niklas Thur, Theresa Will, Klaus Peter Janssen, Katja Steiger, Moritz Jesinghaus, Klaus Neuhaus, Michael Quante, Dirk HallerMohamed Abdelhafez, Roland M. Schmid, Moritz Middelhoff

Research output: Contribution to journalArticlepeer-review


Introduction: The identification of risk factors for precursor lesions of colorectal cancer (CRC) holds great promise in the context of prevention. With the current study we aimed to identify patient characteristics associated with colorectal polyps (CP) and polyp features of potential malignant progression. Furthermore, a potential association with gut microbiota in this context was investigated. Methods: In this single center study, a total of 162 patients with colorectal polyps and 91 control patients were included. Multiple variables including information on lifestyle, diet, serum parameters and gut microbiota, analyzed by 16S-rRNA gene amplicon sequencing and functional imputations (Picrust2), were related to different aspects of CP. Results: We observed that elevated serum alkaline phosphatase (AP) levels were significantly associated with the presence of high-grade dysplastic polyps. This association was further seen for patients with CRC. Thereby, AP correlated with other parameters of liver function. We did not observe significant changes in the gut microbiota between patients with CP and their respective controls. However, a trend towards a lower alpha-diversity was seen in patients with CRC. Interestingly, AP was identified as a possible clinical effect modifier of stool sample beta diversity. Conclusion: We show for the first time an increased AP in premalignant CP. Furthermore, AP showed a significant influence on the microbial composition of the intestine. Relatively elevated liver enzymes, especially AP, may contribute to the detection of precancerous dysplastic or neoplastic changes in colorectal lesions. The association between elevated AP, premalignant CP, and the microbiome merits further study.

Original languageEnglish
JournalClinical and Translational Gastroenterology
StateAccepted/In press - 2023


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