Ileal Pouch Morphology and Microbiology in Ulcerative Colitis Patients

Abstract

Background. Ideal pouch created during restorative proctocolectomy is a new gastrointestinal organ -"neorectum". Although it is made from the ileum, it takes over function of the removed rectum. This new function results in significant morphological changes in pouch's mucous membrane, which becomes similar to the large bowel mucosa. The most common pathology of the ileal pouch is its inflammation -pouchitis. One of the suspected causes of pouchitis is bacterial flora disturbance. Objectives. The aim of the study was to analyze the morphological and microbiological changes in ileal pouches in different time periods after ileostomy closure and to evaluate the influence of certain bacterial strains on the degree of inflammation. Material and Methods. The study involved 47 patients who had been treated surgically; they were investigated before and at different stages after ileostomy closure. They underwent repeated rectoscopies with biopsies of pouch mucosa and swabs for microbiological examination. In total 89 rectoscopies were performed, which provided 70 histopathological results according to the Heidelberg Pouchitis Activity Score and 87 microbiological test results. Results. The assessment of the morphology of intestinal pouches showed increased signs of chronic inflammation as the length of time after the closure of a protective ileostomy increased. There was no correlation between the signs of acute inflammation and the length of time after surgery; there were more signs of acute inflammation in cases of pouchitis. The composition of the bacterial flora of intestinal pouches changed as the length of time after ileostomy closure increased, with significant increases in the number of enterobacteriaceae species. The presence of Staphylococcus aureus significantly correlates with a higher degree of chronic inflammation; this bacterium may be a potential infectious factor in pouchitis. Conclusions. Microbiological analysis of intestinal pouch lumen is a useful tool that can be used in routine follow-up assessment of intestinal pouches as well as in diagnosing pouchitis (Adv Clin Exp Med 2015, 24, 2, 267-274).

The Microbiota Profile in Inflamed and Non-Inflamed Ileal Pouch–Anal Anastomosis

“…Our research group found no difference between the present of S. aureus in faecal cultures in patients with chronic pouchitis compared to the Danish background population (data not published). Contradictory to the findings of Pawełka et al [ 32 ], Tannock et al reported a significantly lower number of Enterococcus spp ., Faecalibacterium prausnitzii , Clostridium spp ., Ruminococcus spp ., Eubacterium spp ., Lachnospiraceae and Insertae Sedis XIV in chronic pouchitis compared to healthy individuals, by use of faecal cultivation [ 33 ].…”

“…Another study by Pawełka et al found that chronic pouchitis or patients in need of long-term antibiotic treatment to control symptoms of pouchitis were associated with a significantly higher numbers of Staphylococcus aureus in faecal cultures [ 32 ]. Our research group found no difference between the present of S. aureus in faecal cultures in patients with chronic pouchitis compared to the Danish background population (data not published).…”

Ileal Pouch–Anal Anastomosis and Pouchitis: The Role of the Microbiota in the Pathogenesis and Therapy

“…In particular, subjects with pouchitis display decreased levels of Bacteroidetes [50,52,53], Lachnospiraceae [44,49], Ruminococcaceae [49], Streptococci [47,54], and Faecalibacterium [49], while incremented levels of Enterobacteriaceae (including E.Coli) [47,49] Fusobacterium [54,55], and Propionibacterium acnes [56] have been observed. Furthermore, Lim et al identified seventeen operational taxonomic units that were seen exclusively in subjects with inflamed pouches including Desulfosporosinus, Leptospira, Microcystis, Methylobacter, and Pseudoalteromonas [57], while Pawelka et al observed that the presence of Staphylococcus aureus correlated with a higher degree of chronic inflammation [58]. Ruminococcaceae and Lachnospiraceae have an important role in preserving the host's health due to their ability to hydrolyze starch and other sugars producing butyrate and other short-chain fatty acids (SCFAs), which are considered the principal nutrients of the colonic epithelial cells [59].…”

Diarrhea in a 54-year-old patient after total colectomy

“…1, 2016 РЖГГК он-лайн -www.gastro-j.ru ков, выраженных в баллах. Диагноз паучита считается достоверным при сумме баллов 13 и более [17] [10]. Таким образом, мальабсорбция может быть рассмотрена как одна из составляющих возникновения диареи у наблюдавшейся пациентки.…”