Mucosal fungal dysbiosis is associated with early postoperative endoscopic recurrence after bowel resection for Crohn’s disease

PURPOSE: Anastomotic recurrence after ileocolectomy for Crohn's disease may be related to the gut microbiota, but the role of mycobiota remains unclear. This study aimed to investigate associations between mucosal mycobiota at resection and early postoperative endoscopic recurrence, and assess their predictive potential. METHODS: We recruited 55 Crohn's disease patients undergoing bowel resection (October 2022-February 2024) with one-year endoscopic follow-up. Mucosal samples obtained during surgery underwent fungal internal transcribed spacer 1 sequencing to characterize the fungal communities. Multivariate analysis identified risk factors for early postoperative endoscopic recurrence. Predictive model performance was evaluated using receiver operating characteristic curve analysis. RESULTS: Twenty patients (36.4%) developed early postoperative endoscopic recurrence and were assigned to the recurrence group. Multivariate analysis identified preoperative low serum albumin level and elevated postoperative neutrophil-to-lymphocyte ratio as independent risk factors. The recurrence group exhibited an increased relative abundance of Basidiomycota, an elevated Basidiomycota/Ascomycota ratio, and heightened relative abundances of Malassezia restricta and Debaryomyces hansenii. A combined predictive model integrating three potential fungal biomarkers demonstrated superior predictive performance for early postoperative endoscopic recurrence. CONCLUSION: Early postoperative endoscopic recurrence in Crohn's disease is significantly associated with mucosal fungal dysbiosis during bowel resection. Integrating mycobial factors can more effectively predict early postoperative endoscopic recurrence.