title: Association of Enteric Protist Blastocystis spp. and Gut Microbiota with Hepatic Encephalopathy.
abstract: OBJECTIVE
  Hepatic encephalopathy (HE) is a serious neuropsychiatric sequela emerging in the advanced stages of cirrhosis. The gut microbiota plays an important role in the development of HE. The aim of the study was to analyze the dynamic interplay between microbiota and Blastocystis in cirrhotic patients with or without encephalopathy.
  
  
  METHODS
  The study was designed as cross-sectional study. A total of 37 patients from the Ankara city, admitted to the University Hospital within a 6-month period prior to enrolment into the study were included in the study. After the regular health checks, clinical histories, clinical examinations, and Psychometric HE Score (PHES) points, patients' MELD and CTP scores were recorded. The fecal microbiota configurations were characterized by targeting hypervariable regions V3 and V4 of the 16S rRNA gene using Illumina MiSeq System.
  
  
  RESULTS
  Blastocystis spp. were detected in 21.6% (n = 8) of all cirrhotic patients. When those were analyzed by subgroups, four of them were subtype 2, three were subtype 3 and one was subtype 1. Blastocystis spp. were not found in any of the patients with HE; however, they were detected in 38.1% of the patients without HE. Also the increase in the bacterial diversity was observed along with the absence of Blastocystis. It was suggested that there was an inverse relationship between Blastocystis spp. and advanced stages of HE and the structure and composition of gut microbiota.
  
  
  CONCLUSIONS
  The absence of Blastocystis spp. is associated with the HE severity and dysbiosis in the gut microbiota.
authors.affiliation: Etimesgut Sait Ertürk State Hospital, Ankara, Turkey. drsedatyildiz06@gmail.com.
authors.forename: Sedat
authors.initials: S
authors.lastname: Yildiz
authors.affiliation: Section of Gastroenterology, Department of Internal Disease, Faculty of Medicine, Gazi University, Ankara, Turkey.
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Doğan
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey.
authors.forename: Funda
authors.initials: F
authors.lastname: Doğruman-Al
authors.affiliation: Computer Engineering Department,Genome and Stem Cell Center, Erciyes University, Kayseri, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Nalbantoğlu
authors.affiliation: Medipol University International Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey.
authors.forename: Duran
authors.initials: D
authors.lastname: Üstek
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey.
authors.forename: Fakhriddin
authors.initials: F
authors.lastname: Sarzhanov
authors.affiliation: Medipol University International School of Medicine, Department of Medical Microbiology, İstanbul, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Yildirim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D016844:Blastocystis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D016776:Blastocystis Infections / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology*; D003430:Cross-Sectional Studies; D064806:Dysbiosis; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D000069196:Gastrointestinal Microbiome; D041981:Gastrointestinal Tract / Q000382:microbiology* / Q000469:parasitology*; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000469:parasitology*; D006785:Hospitals, University; D054884:Host-Pathogen Interactions; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000469:parasitology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D021521:Ribotyping; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult