***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND  Anastomotic leak after esophagectomy remains a significant source of morbidity and mortality . The gastrointestinal ( GI ) microbiome has been found to play a significant role in tumor oncogenesis and postoperative bowel anastomotic leak . We hypothesized that the GI microbiome could differentiate between esophageal cancer histologies and predict postoperative anastomotic leak . METHODS A prospect i ve study of esophagectomy patients was performed from May 2013 to August 2014 , with the collection of oral saliva , intraoperative esophageal and gastric mucosa , and sample s of postoperative infections ( neck swab or sputum ) . The presence and level for each bacterial probe as end points were used to analyze correlations with tumor histology , tumor stage , and presence of postoperative complications by unequal variances t tests for multiple comparisons and principal coordinate analysis . RESULTS Esophagectomy was successful in 55 of 66 patients who were enrolled . Among those , the diagnosis was adenocarcinoma in 44 ( 80 % ) squamous cell carcinoma in ( 13 % ) , and benign disease in 4 ( 7 % ) . The 30-day mortality was 1.8 % ( 1 of 55 ) . Complications included anastomotic leak requiring local drainage in 18 % ( 10 of 55 ) and postoperative pneumonia in 2 % ( 1 of 55 ) . No correlation was noted between GI microbiome flora and tumor histology or tumor stage . A significant difference ( p = 0.015 ) was found when the variance in bacterial composition between the preoperative oral flora was compared with intraoperative gastric flora in patients who had a leak but not in patients with pneumonia . CONCLUSIONS Patients with anastomotic leaks had increased variance in their preoperative oral and gastric flora . Microbiome analysis could help identify patients at higher risk for leak after esophagectomy Background and Objectives Bariatric surgery improves metabolic diseases and alters the intestinal microbiota in animals and humans , but different procedures reportedly have different impacts on the intestinal microbiota . We developed laparoscopic sleeve gastrectomy with duodenojejunal bypass ( LSG-DJB ) as an alternative to laparoscopic Roux-en-Y gastric bypass ( LRYGB ) in addition to laparoscopic sleeve gastrectomy ( LSG ) for Japanese patients with obesity . We investigated the precise change in the intestinal microbiota induced by these procedures in the present study . Methods A prospect i ve observational study of 44 Japanese patients with obesity was conducted [ 22 patients underwent LSG , 18 underwent LSG-DJB , and 4 underwent laparoscopic adjustable gastric b and ing ( LAGB ) ] . The patients ’ clinical parameters and intestinal microbiota were investigated before and for 6 months after surgery . The microbiota was analyzed by a 16S rDNA method . Results LSG and LSG-DJB significantly improved the metabolic disorders in the patients with obesity . The proportion of the phylum Bacteroidetes and order Lactobacillales increased significantly in the LSG group , and that of the order Enterobacteriales increased significantly in the LSG-DJB group . Conclusions LSG and LSG-DJB improved obesity and type 2 diabetes in Japanese patients with obesity , but the impact of LSG-DJB on the intestinal microbiota differed from that of LSG . This difference in the impact on the intestinal environment could explain the different efficacies of LSG and LSG-DJB in terms of their ability to resolve metabolic disorders in the clinical setting BACKGROUND The intestinal microbiota is implicated in the pathogenesis of ulcerative colitis . Faecal microbiota transplantation is a novel form of therapeutic microbial manipulation , but its efficacy in ulcerative colitis is uncertain . We aim ed to establish the efficacy of intensive-dosing , multidonor , faecal microbiota transplantation in active ulcerative colitis . METHODS We conducted a multicentre , double-blind , r and omised , placebo-controlled trial at three hospitals in Australia . We r and omly allocated patients with active ulcerative colitis ( Mayo score 4 - 10 ) in a 1:1 ratio , using a pre-established r and omisation list , to either faecal microbiota transplantation or placebo colonoscopic infusion , followed by enemas 5 days per week for 8 weeks . Patients , treating clinicians , and other study staff were unaware of the assigned treatment . Faecal microbiota transplantation enemas were each derived from between three and seven unrelated donors . The primary outcome was steroid-free clinical remission with endoscopic remission or response ( Mayo score ≤2 , all subscores ≤1 , and ≥1 point reduction in endoscopy subscore ) at week 8 . Analysis was by modified intention-to-treat and included all patients receiving one study dose . We performed 16S rRNA stool analysis to assess associated microbial changes . This trial is registered with Clinical Trials.gov , number NCT01896635 . The trial has ended ; this report presents the final analysis . FINDINGS From November , 2013 , to May , 2015 , 85 patients were enrolled to our trial , of whom 42 were r and omly assigned faecal microbiota transplantation and 43 were allocated placebo . One patient assigned faecal microbiota transplantation and three allocated placebo did not receive study treatment and were excluded from the analysis . The primary outcome was achieved in 11 ( 27 % ) of 41 patients allocated faecal microbiota transplantation versus three ( 8 % ) of 40 who were assigned placebo ( risk ratio 3·6 , 95 % CI 1·1 - 11·9 ; p=0·021 ) . Adverse events were reported by 32 ( 78 % ) of 41 patients allocated faecal microbiota transplantation and 33 ( 83 % ) of 40 who were assigned placebo ; most were self-limiting gastrointestinal complaints , with no significant difference in number or type of adverse events between treatment groups . Serious adverse events occurred in two patients assigned faecal microbiota transplantation and in one allocated placebo . Microbial diversity increased with and persisted after faecal microbiota transplantation . Several bacterial taxa were associated with clinical outcome ; in particular , the presence of Fusobacterium spp was associated with lack of remission . INTERPRETATION Intensive-dosing , multidonor , faecal microbiota transplantation induces clinical remission and endoscopic improvement in active ulcerative colitis and is associated with distinct microbial changes that relate to outcome . Faecal microbiota transplantation is , thus , a promising new therapeutic option for ulcerative colitis . Future work should focus on precisely defining the optimum treatment intensity and the role of donor-recipient matching based on microbial profiles . FUNDING Broad Medical Research Program , Gastroenterological Society of Australia , Mount Sinai ( New York ) SUCCESS fund , University of New South Wales Background Roux-en-Y gastric bypass ( RYGB ) is an effective means to achieve sustained weight loss for morbidly obese individuals . Besides rapid weight reduction , patients achieve major improvements of insulin sensitivity and glucose homeostasis . Dysbiosis of gut microbiota has been associated with obesity and some of its co-morbidities , like type 2 diabetes , and major changes of gut microbial communities have been hypothesized to mediate part of the beneficial metabolic effects observed after RYGB . Here we describe changes in gut microbial taxonomic composition and functional potential following RYGB . Methods We recruited 13 morbidly obese patients who underwent RYGB  , carefully phenotyped them , and had their gut microbiomes quantified before ( n = 13 ) and 3 months ( n = 12 ) and 12 months ( n = 8) after RYGB . Following shotgun metagenomic sequencing of the fecal microbial DNA purified from stools , we characterized the gut microbial composition at species and gene levels followed by functional annotation . Results In parallel with the weight loss and metabolic improvements , gut microbial diversity increased within the first 3 months after RYGB and remained high 1 year later . RYGB led to altered relative abundances of 31 species ( P < 0.05 , q < 0.15 ) within the first 3 months , including those of Escherichia coli , Klebsiella pneumoniae , Veillonella spp . , Streptococcus spp . , Alistipes spp . , and Akkermansia muciniphila . Sixteen of these species maintained their altered relative abundances during the following 9 months . Interestingly , Faecalibacterium prausnitzii was the only species that decreased in relative abundance . Fifty-three microbial functional modules increased their relative abundance between baseline and 3 months ( P < 0.05 , q < 0.17 ) . These functional changes included increased potential ( i ) to assimilate multiple energy sources using transporters and phosphotransferase systems , ( ii ) to use aerobic respiration , ( iii ) to shift from protein degradation to putrefaction , and ( iv ) to use amino acids and fatty acids as energy sources . Conclusions Within 3 months after morbidly obese individuals had undergone RYGB , their gut microbiota featured an increased diversity , an altered composition , an increased potential for oxygen tolerance , and an increased potential for microbial utilization of macro- and micro-nutrients . These changes were maintained for the first year post-RYGB.Trial registration Current controlled trials ( ID NCT00810823 , NCT01579981 , and NCT01993511 ) Summary Bariatric surgery is currently the most effective procedure for the treatment of obesity . Given the role of the gut microbiota in regulating host metabolism and adiposity , we investigated the long-term effects of bariatric surgery on the microbiome of patients r and omized to Roux-en-Y gastric bypass or vertical b and ed gastroplasty and matched for weight and fat mass loss . The two surgical procedures induced similar and durable changes on the gut microbiome that were not dependent on body mass index and result ed in altered levels of fecal and circulating metabolites compared with obese controls . By colonizing germ-free mice with stools from the patients , we demonstrated that the surgically altered microbiota promoted reduced fat deposition in recipient mice . These mice also had a lower respiratory quotient , indicating decreased utilization of carbohydrates as fuel . Our results suggest that the gut microbiota may play a direct role in the reduction of adiposity observed after bariatric surgery Introduction Type 2 diabetes ( T2D ) in association with obesity is an increasing disease burden . Bariatric surgery is the only effective therapy for achieving remission of T2D among those with morbid obesity . It is unclear which of the two most commonly performed types of bariatric surgery , laparoscopic sleeve gastrectomy ( LSG ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) , is most effective for obese patients with T2D . The primary objective of this study is to determine whether LSG or LRYGB is more effective in achieving HbA1c<6 % ( < 42 mmol/mol ) without the use of diabetes medication at 5 years . Methods and analysis Single-centre , double-blind ( assessor and patient ) , parallel , r and omised clinical trial ( RCT ) conducted in New Zeal and , targeting 106 patients . Eligibility criteria include age 20–55 years , T2D of at least 6 months duration and body mass index 35–65 kg/m2 for at least 5 years . R and omisation 1:1 to LSG or LRYGB , used r and om number codes disclosed to the operating surgeon after induction of anaesthesia . A st and ard medication adjustment schedule will be used during postoperative metabolic assessment s. Secondary outcomes include proportions achieving HbA1c<5.7 % ( 39 mmol/mol ) or HbA1c<6.5 % ( 48 mmol/mol ) without the use of diabetes medication , comparative weight loss , obesity-related comorbidity , operative complications , revision rate , mortality , quality of life , anxiety and depression scores . Exploratory outcomes include changes in satiety , gut hormone and gut microbiota to gain underlying mechanistic insights into T2D remission . Ethics and dissemination Ethics approval was obtained from the New Zeal and regional ethics committee ( NZ93405 ) who also provided independent safety monitoring of the trial . Study commenced in September 2011 . Recruitment completed in October 2014 . Data collection is ongoing . Results will be reported in manuscripts su bmi tted to peer- review ed journals and in presentations at national and international meetings . Trial registration numbers ACTRN12611000751976 , NCT01486680 ; Pre- results Evidence suggests a correlation between the gut microbiota composition and weight loss caused by caloric restriction . Laparoscopic sleeve gastrectomy ( LSG ) , a surgical intervention for obesity , is classified as predominantly restrictive procedure . In this study we investigated functional weight loss mechanisms with regard to gut microbial changes and energy harvest induced by LSG and a very low calorie diet in ten obese subjects ( n = 5 per group ) demonstrating identical weight loss during a follow-up period of six months . For gut microbiome analysis next generation sequencing was performed and faeces were analyzed for targeted metabolomics . The energy 
    Output:
    
Bariatric surgery results in sustained weight loss , improvement of metabolic and hormonal changes , and reduction of comorbidities in obese patients .
These changes were associated with weight loss .
Bariatric surgery induces profound changes in the microbiome .
This may be related to the beneficial effect of bariatric surgery on comorbidities associated with obesity