Diversion Colitis and Probiotic Stimulation: Effects of Bowel Stimulation Prior to Ileostomy Closure

Rodríguez-Padilla, Ángela; Morales-Martín, Germán; Pérez-Quintero, Rocío; Rada-Morgades, Ricardo; Gómez‐Salgado, Juan; Ruiz‐Frutos, Carlos

doi:10.3389/fmed.2021.654573

Cited by 7 publications

(8 citation statements)

References 45 publications

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“…The loss of diversity together with SCFA-producing bacteria is consistent with inflammatory states such as in IBD as confirmed by other studies (Ferrie et al, 2020). While the direction of cause and effect is not immediately clear, a recent RCT found that probiotic stimulation of the diverted bowel loops significantly improved clinical and histological signs of severe and moderate DC in 100% and 88% of patients, respectively (Rodríguez-Padilla et al, 2021). This points towards an active role of the microbiome in modulating immunity and function rather than simply being a biomarker of dysbiosis.…”

Section: Resultsmentioning

confidence: 99%

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The impact of faecal diversion on the gut microbiome: a systematic review

Sam,

Hafeez,

Ong

et al. 2024

Gut. Microb.

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Diversion of the faecal stream is associated with diversion colitis (DC). Preliminary studies indicate that microbiome dysbiosis contributes to its development and potentially treatment. This review aims to characterise these changes in the context of faecal diversion and identify their clinical impact. A systematic search was conducted using MEDLINE, EMBASE and CENTRAL databases using a predefined search strategy identifying studies investigating changes in microbiome following diversion. Findings reported according to PRISMA guidelines. Of 743 results, 6 met inclusion criteria. Five reported significantly decreased microbiome diversity in the diverted colon. At phylum level, decreases in Bacillota with a concomitant increase in Pseudomonadota were observed, consistent with dysbiosis. At genus level, studies reported decreases in beneficial lactic acid bacteria which produce short-chain fatty acid (SCFA), which inversely correlated with disease severity. Significant losses in commensals were also noted. These changes were seen to be partially reversible with restoration of bowel continuity. Changes within the microbiome were reflected by histopathological findings suggestive of intestinal dysfunction. Faecal diversion is associated with dysbiosis in the diverted colon which may have clinical implications. This is reflected in loss of microbiome diversity, increases in potentially pathogenic-associated phyla and reduction in SCFA-producing and commensal bacteria.

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Section: Resultsmentioning

confidence: 99%

“…Potentially harmful. Limited data but increases associated with malnutrition and coeliac's (Raineri et al, 2021;Rodríguez-Padilla et al, 2021).…”

Section: Decreasedmentioning

confidence: 99%

The impact of faecal diversion on the gut microbiome: a systematic review

Sam,

Hafeez,

Ong

et al. 2024

Gut. Microb.

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“…Researchers have attempted several approaches to mitigate these complications following ileostomy reversal, including the stimulation of the defunctioned bowel using saline or diluted ileostomy output [ 29 ] and preoperative administration of probiotics [ 30 , 31 ]. However, these interventions currently lack robust clinical evidence.…”

Section: Discussionmentioning

confidence: 99%

Dysbiosis of gut microbiota during fecal stream diversion in patients with colorectal cancer

Lee,

Park,

Kim

et al. 2023

Gut Pathog

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Background The effect of fecal stream diversion on the gut microbiota is still uncertain. The present study was designed to assess the effect of fecal stream diversion on the composition of the gut microbiota in patients with colorectal cancer. We included patients undergoing left-sided colorectal cancer surgery with (ileostomy group) or without (control group) diverting ileostomy. Fecal samples were collected from 10 patients in each group before surgery (t1) and after ileostomy repair in the ileostomy group and 6–12 months after the initial surgery in the control group (t2). The fecal microbiota was assessed using 16S rRNA sequencing, and changes in the composition of the fecal microbiota were compared between the two groups. Results Alpha diversity analysis revealed that the complexity of fecal microbiota decreased between t1 and t2 only in the ileostomy group. Beta diversity analysis also showed dissimilarity between t1 and t2 only in the ileostomy group. The composition of the microbiota was similar between the two groups at t1. However, at t2, the ileostomy group had lower proportion of beneficial bacteria (Lachnospiraceae, 3.8% vs. 29.9%, p < 0.001; Ruminococcaceae, 0.6% vs. 18.4%, p < 0.001; Blautia, 0.1% vs. 9.1%, p < 0.001; Faecalibacterium, 0.2% vs. 7.5%, p < 0.001) and a higher proportion of harmful bacteria (Proteobacteria, 17.9% vs. 5.1%, p = 0.006; Clostridium, 16.2% vs. 1.1%, p = 0.013; Streptococcus, 17.7% vs. 1.6%, p = 0.002) than the control group. Conclusions Fecal stream diversion was closely associated with less diversity and dysbiosis of the gut microbiota.

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“…For this reason, the actual incidence rate of DC might be underestimated. According to studies ( 15 ), the most common symptoms in DC patients are serous, bloody, or mucous stools (40%), followed by abdominal pain and tenesmus (15%). In this study, the incidence rate of abdominal pain, mucus stool, and bloody stool were lower than other studies.…”

Section: Discussionmentioning

confidence: 99%

Interaction between the intestinal flora and the severity of diversion colitis after low anterior resection of rectal cancer

Sun

Yunjie²,

Liang³

et al. 2023

Front. Oncol.

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BackgroundDiversion colitis (DC) is nonspecific inflammation of the distal intestinal mucosa following disruption of colonic continuity with colonic dysfunction. The colonscopic score is a good tool for differentiating the severity of patients with DC. At present, no studies have analyzed the pathogenesis of DC from the perspective of the diversity and and differences of intestinal flora.MethodsRetrospective study: Clinical information were collected from patients with low rectal cancer admitted to the Department of Anorectal Surgery, Changzheng Hospital, from April 2017 to April 2019. These patients underwent laparoscopic low anterior resection (LAR) combined with terminal ileum enterostomy (dual-chamber). We used chi-square test to comparethe clinical baseline information, clinical symptoms, and colonscopic characteristics between different severity of DC. Propsective oberservational study: We recruited 40 patients with laparoscopic anterior low resection combined with terminal ileum enterostomy and they were further classified into mild group and severe group according to the scores of colonscopic examinations for DC. 16s-rDNA sequencing was carried out to analyze the diversity and and differences of intestinal flora in the intestinal lavage fluid of the two groups.ResultsIn retrospective study, we found that age, BMI, history of diabetes, and symptoms associated with the stoma state were the independent risk factors that affect DC severity (P<0.05). Meanwhile, age, BMI, history of diabetes and colonscopic score were found to be independent risk factors affecting the severity of diarrhea after ileostomy closure surgery(P<0.05), which was consistent with our results of differentiating the severity of DC under endoscopy; In propsective oberservational study, 40 patients with low rectal cancer recruited by sample size calculation, 23 were in the mild group and 17 in the severe group. The results of 16s-rDNA sequencing showed that intestinal flora with high enrichment values primarily consisted of Bifidobacteriales and Prevotella in mild group, whereas that in the severe group consisted of Providencia and Dorea. The functional predictions on such two types of intestinal flora were mainly focused on lipid synthesis, glycan synthesis, metabolism, and amino acid metabolism pathways.ConclusionAfter ileostomy closure surgery, a series of severe clinical symptoms might appear in DC patients. There are significant differences in local and systemic inflammatory responses, composition of intestinal flora between DC patients with different colonscopic scores, which provide a basis for the clinical interventional treatment for DC in patients with permanent stoma.

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Diversion Colitis and Probiotic Stimulation: Effects of Bowel Stimulation Prior to Ileostomy Closure

Cited by 7 publications

References 45 publications

The impact of faecal diversion on the gut microbiome: a systematic review

The impact of faecal diversion on the gut microbiome: a systematic review

Dysbiosis of gut microbiota during fecal stream diversion in patients with colorectal cancer

Interaction between the intestinal flora and the severity of diversion colitis after low anterior resection of rectal cancer

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