Original CommunicationBacterial population moves toward a colon-like community in the pouch after total proctocolectomy
Section snippets
Samples
Samples were collected from 49 patients who had undergone TPC with IPAA (all for UC) and 31 healthy volunteers (Table I). Diagnosis of UC was based on a combination of clinical symptoms, endoscopic findings, and histologic examination. None of the healthy volunteers was treated with any medications. At Tohoku University Hospital, patients with UC underwent routinely a 2- or 3-step operative approach, after which the ileal pouch becomes “functional” after complete closure of the covering loop
Recovery of the fecal DNA
Adequate quantities and quality of DNA samples were obtained from watery stool samples. DNA concentrations ranged between 10.5 (±2.1) ng/mg stool in the ileostomy group, 14.8 (±2.3) ng/mg in patients with a new ileal pouch (within 2 years of ileostomy closure), and 30.1 (±7.7) ng/mg in patients with an established ileal pouch (>2 years since ileostomy closure). In contrast, DNA concentrations in the control group averaged 920.9 (±320.9) ng/mg.
T-RFLP analysis and clustering of fecal bacteria
Diversity of bacterial composition in fecal samples
Discussion
First of all, this study was intended to display the difference of fecal bacterial communities between samples from the ileostomy, ileal pouch, and colon. In a dendrogram analysis, stool samples from patients with ileostomy, with an ileal pouch within or more than 2 years after ileostomy closure, and from controls were categorized into 4 clusters. In further analyses of clustering of samples from the ileal pouch, we found that the median time of formation of a “functional” pouch after ileostomy
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The Structure and Function of the Human Small Intestinal Microbiota: Current Understanding and Future Directions
2020, Cellular and Molecular Gastroenterology and HepatologyCitation Excerpt :In patients with multiple-stage IPAA surgery, biopsy specimens upstream from the ileostomy at the time of stoma closure harbor predominantly facultative anaerobes (eg, Lactobacilli, Enterococci, and coliforms), a paucity of sulfate-reducing bacteria, and low levels of Clostridium perfringens.96 After ileostomy closure, the bacterial biomass increases in the ileal pouch, and populations shift with decreased facultative anaerobes and increased obligate anaerobes, sulfate-reducing bacteria, and Clostridia species,96–98 which is much more prominent in ulcerative colitis (UC) pouches compared with FAP. Mucosal adaptation occurs in maturing ileal pouches, and the presence of feces has been associated with colonic metaplasia and transformed mucin glycosylation.99
Ileal Pouch Complications
2019, Surgical Clinics of North AmericaCitation Excerpt :The reservoir function of an ileal pouch creates in fecal stasis on the small bowel mucosa resulting in metaplastic changes of villus blunting and chronic inflammation.19 The microbiome of the pouch transitions with an increase in colonization by bacterial species more typical of colonic flora.20 It is the combination of these factors, and likely others yet to be elucidated, that result in the syndrome of pouchitis.
Etiology and pathogenesis of pouchitis
2017, Seminars in Colon and Rectal SurgeryCitation Excerpt :The bacterial shifts may increase sulfate reduction, change bile salt composition and impact the generation of short chain fatty acids.13 Studies making use of terminal restriction fragment length polymorphism (T-RFLP) analysis comparing the microbiota of patients with IPAA for UC and normal controls showed a transition over time to bacteria more common to the colon.19 Further analysis suggests that the changes occurred over the first year after ileostomy closure with little change after that.
Pouch Inflammation Is Associated with a Decrease in Specific Bacterial Taxa
2015, GastroenterologyCitation Excerpt :Our follow-up of highly phenotyped pouch patients enabled us to address the question of whether the microbial composition of an “aging” pouch changes, and specifically, whether “colonic adaptation” occurs. Previous investigations of normal pouch patients suggested their fecal microbiota became more colon-like during the first 2 years,40 and that species typical of a normal colonic microbiota increased in pouches older than 1 year.41 However, the degree of overall similarity of the normal pouch microbiota to a normal colon remained unclear.
Very Early Pouchitis Is Associated with an Increased Likelihood of Chronic Inflammatory Conditions of the Pouch
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