The therapeutic potential of short-chain fatty acids enemas in inflammatory bowel diseases: a systematic review

Kaczmarek, Nina; Kokot, Marta; Makarewicz, Aleksandra; Glapa-Nowak, Aleksandra; Nowak, Jan; Jamka, Małgorzata; Walkowiak, Jarosław

doi:10.32383/farmpol/125114

Cited by 3 publications

(3 citation statements)

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“…For example, Guillemot et al [ 19 ] did not observe any improvement of endoscopic and histologic lesions in patients with diversion colitis after 14 days of SCFA irrigation. Similarly, a recent systematic review including four studies with a total of 187 patents fails to show any benefits of SCFA enemas in IBD patients [ 20 ]. Some of the results that we present in this review will probably help explain the paradoxical results obtained from these clinical studies.…”

Section: The Gut Microbiota In Health and Ibdsmentioning

confidence: 99%

Butyrate and the Fine-Tuning of Colonic Homeostasis: Implication for Inflammatory Bowel Diseases

Gasaly

Hermoso

Gotteland

2021

IJMS

111

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This review describes current evidence supporting butyrate impact in the homeostatic regulation of the digestive ecosystem in health and inflammatory bowel diseases (IBDs). Butyrate is mainly produced by bacteria from the Firmicutes phylum. It stimulates mature colonocytes and inhibits undifferentiated malignant and stem cells. Butyrate oxidation in mature colonocytes (1) produces 70–80% of their energetic requirements, (2) prevents stem cell inhibition by limiting butyrate access to crypts, and (3) consumes oxygen, generating hypoxia and maintaining luminal anaerobiosis favorable to the microbiota. Butyrate stimulates the aryl hydrocarbon receptor (AhR), the GPR41 and GPR109A receptors, and inhibits HDAC in different cell types, thus stabilizing the gut barrier function and decreasing inflammatory processes. However, some studies indicate contrary effects according to butyrate concentrations. IBD patients exhibit a lower abundance of butyrate-producing bacteria and butyrate content. Additionally, colonocyte butyrate oxidation is depressed in these subjects, lowering luminal anaerobiosis and facilitating the expansion of Enterobacteriaceae that contribute to inflammation. Accordingly, gut dysbiosis and decreased barrier function in IBD seems to be secondary to the impaired mitochondrial disturbance in colonic epithelial cells.

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Section: The Gut Microbiota In Health and Ibdsmentioning

confidence: 99%

Butyrate and the Fine-Tuning of Colonic Homeostasis: Implication for Inflammatory Bowel Diseases

Gasaly

Hermoso

Gotteland

2021

IJMS

111

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“…Furthermore, in this systematic review, we included only studies in which butyrate alone (and not as a part of the SCFA mixture) was used. However, our previous systematic review demonstrated no evidence for the effectiveness of SCFA enemas in IBD patients [50].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Sodium Butyrate Enemas Compared with Placebo on Disease Activity, Endoscopic Scores, and Histological and Inflammatory Parameters in Inflammatory Bowel Diseases: A Systematic Review of Randomised Controlled Trials

et al. 2020

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Introduction: Administration of butyrate enemas might improve the health status of patients with inflammatory bowel disease (IBD). However, the results seem equivocal. Therefore, this systematic review aimed to assess the effect of sodium butyrate enemas on disease activity index (DAI), endoscopic scores, as well as histological and inflammatory parameters in IBD patients. Methods: The PubMed, Scopus, Web of Science, and Cochrane databases were searched. Randomised controlled trials published in English that assessed the effect of butyrate enemas on DAI, clinical symptoms, inflammatory markers, as well as histological and endoscopic scores in patients with Crohn’s disease (CD) and ulcerative colitis (UC) were included in the analysis. Results: Eight studies involving 227 UC patients were included in this analysis. Only one study reported significant differences in DAI between groups. Besides, butyrate treatment groups did not differ significantly from controls concerning the effect on endoscopic and histological scores. Moreover, butyrate enemas exerted a significant effect on few inflammatory parameters measured in colonic mucosal biopsies. Conclusion: The current evidence is limited and does not support the application of butyrate enemas in UC. There are no reliable data regarding the efficacy of butyrate enemas in CD. The systematic review protocol was registered in the PROSPERO database (CRD42020163654).

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“…The stimulation of the rectum was not evaluated in these previous trials. Rectal enemas are often used and tolerated as routine treatment for several conditions, such as inflammatory bowel disease and chronic constipation [18][19][20][21]. Consequently, theoretically, enemas could be easier for patients to adhere to an excluded intestinal stimulus protocol.…”

Section: Introductionmentioning

confidence: 99%

Rectal stimulation with prebiotics and probiotics before ileostomy reversal: a study protocol for a randomized controlled trial

Marcelino

Tustumi

Gerbasi

et al. 2023

Trials

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Background Ileostomy closure is associated with a high rate of postoperative morbidity, and adynamic ileus is the most common complication, with an incidence of up to 32%. This complication is associated with delayed initiation of oral diet intake, abdominal distention, prolonged hospital stay, and more significant patient discomfort. The present study aims to evaluate the rectal stimulus with prebiotics and probiotics before ileostomy reversal. Methods This is a protocol study for an open-label randomized controlled clinical trial. Ethical approval was received (CAAE: 56551722.6.0000.0071). The following criteria will be used for inclusion: adult patients with rectal cancer stages cT3/4Nx or cTxN+ that underwent loop protection ileostomy, patients treated with neoadjuvant chemoradiotherapy, and patients who underwent laparoscopic or robotic total mesorectal excision. Patients will be randomized to one of two groups. The intervention group (with rectal stimulus): the patients will apply 500 ml of saline solution with 6 g of Simbioflora® rectally, once a day, for 15 days before ileostomy closure. The control group (without rectal stimulation): the patients will close the ileostomy with no previous rectal stimulus. The primary outcomes will be the adynamic ileus (need for postoperative nasogastric tube insertion; nausea/vomiting; or intolerance to oral feedings within the first 72 h) and intestinal transit (time to first evacuation/flatus). Results The patient’s enrollment starts in January 2023. We expect to finish in July 2025. Discussion The findings of this randomized clinical study may have important implications for managing patients undergoing ileostomy reversal. Trial registration This study is registered in the Brazilian Trial Registry (ReBEC) under RBR-366n64w. Registration date: 19/07/2022

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The therapeutic potential of short-chain fatty acids enemas in inflammatory bowel diseases: a systematic review

Cited by 3 publications

References 0 publications

Butyrate and the Fine-Tuning of Colonic Homeostasis: Implication for Inflammatory Bowel Diseases

Butyrate and the Fine-Tuning of Colonic Homeostasis: Implication for Inflammatory Bowel Diseases

The Effect of Sodium Butyrate Enemas Compared with Placebo on Disease Activity, Endoscopic Scores, and Histological and Inflammatory Parameters in Inflammatory Bowel Diseases: A Systematic Review of Randomised Controlled Trials

Rectal stimulation with prebiotics and probiotics before ileostomy reversal: a study protocol for a randomized controlled trial

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