Diversion colitis 25 years later: the phenomenon of the disease

Abstract

BackgroundDiversion colitis (DC) seems to be common in stoma patients, and the restoration of the continuity of the digestive tract is crucial for relief from the inflammatory process. No prospective studies of the late effects of DC on the lower gastrointestinal (GI) tract mucosa and the clinical condition of patients have been reported.MethodsData from 23 patients who underwent stoma creation were analysed during the reversal period (A) and at an average of 3 months (B1) and 5.6 years (B2) after restoration of GI tract continuity. Every monitoring visit included endoscopy, histology and assessment of the clinical condition of patients.ResultsShortly after GI tract restoration (B1), a significant decrease in inflammation was observed. The Ki67 positivity percentage increased, but this was not significant. At an average of 5.6 years after restoration (group B2), the clinical symptoms were mild. More patients presented with endoscopically detected inflammation of the mucosa, but its severity was not significantly higher than that at 3 months after reversal. Histological inflammation was more common, and its severity was significantly higher than that shortly after reversal but similar to that before reversal. The Ki67 positivity percentage decreased at the last examination (B2).ConclusionsThe results of this study show a complex recurrence of histological inflammation several years after GI tract restoration but without clinical and endoscopic inflammation and with good clinical condition. DC can potentially have a late influence on the rectal mucosa, even after stoma closure.

Deviation of the Fecal Stream in Colonic Bowel Segments Results in Increased Numbers of Isolated Lymphoid Follicles in the Submucosal Compartment in a Novel Murine Model of Diversion Colitis

“…Severe clinical courses have been described sporadically [ 3 , 24 , 25 ]. However, symptoms can persist even after reversal of fecal diversion and negatively affect the quality of life [ 5 , 23 , 26 ]. In patients where reestablishment of intestinal continuity is not feasible, surgical resection of the dysfunctioned bowel segment may be necessary when medical anti-inflammatory treatment fails.…”

Non-IBD and Noninfectious Colitis

“…Diversion colitis, first described by Glotzer et al in 1981(Glotzer et al 1981Szczepkowski et al 2017), is a nonspecific inflammatory disorder that occurs months to years after ileostomy or colostomy with resultant deficiency of short-chain fatty acids and other luminal nutrients due to diversion of the fecal stream in the distal bypassed colon (Geraghty and Talbot 1991;Roediger 1990). Restoration of intestinal continuity (reanastomosis) promptly restores the affected bowel to normality (Geraghty and Talbot 1991;Whelan et al 1994).…”

A closer look at the stoma: multimodal imaging of patients with ileostomies and colostomies

“…Symptoms may include pelvic discomfort, anorectal pain, tenesmus, mucous or bloody discharge, and are unrelated with severity of histologic changes. Interestingly, symptoms and inflammation are reversible after restoration of intestinal continuity [21, 22].…”

“…17D–F). Unfortunately, these cross-sectional imaging closely resemble those of active IBD, therefore integration with clinical and endoscopic information is required when recanalisation is being considered in patients with underlying IBD [21, 22].

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