Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis

Abstract

To investigate the etiology of ileal reservoir inflammation, fecal bacteriology and ileal wall morphology were compared in three groups of 15 patients operated on for ulcerative colitis: 1) conventional ileostomy, 2) Kock ileostomy; and 3) pelvic ileal pouch. Total bacterial counts showed overgrowth of fecal bacteria in each group, but the anaerobic bacterial counts were significantly higher (P less than .05) in the two pouch groups than in the conventional ileostomy group. Mucosal morphology did not differ among the three groups showing either normal mucosa or mild chronic inflammatory changes in most patients. In contrast, five of the six patients with clinical pouchitis had acute inflammatory changes in histologic specimens. Fecal bacteriologic findings in these patients did not differ quantitatively or qualitatively from others. It is concluded that proctocolectomy for ulcerative colitis predisposes to ileal bacterial overgrowth, and after pouch operations especially, anaerobic overgrowth may be one factor in the development of pouch inflammation. Acute clinical pouchitis with clear histologic changes was, however, not connected with specific changes in fecal bacteriology.

Clinical and Physiological Aspects of Ileal Pouch-Anal Anastomosis

“…However, bacterial overgrowth alone is probably not sufficient to explain pouchitis, since virtually all pouches have bacterial overgrowth compared to normal ileum or terminal ileostomies. Moreover, quantitative cultures of pouch effluent from patients with pouchitis did not reveal differences in bacterial counts compared with patients without pouchitis (53,57,58).…”

“…It has been suggested that pouchitis is the result of bacterial overgrowth, particu larly of anaerobic bacteria, secondary to stasis in the ileal pouch (53)(54)(55)(56). The generally satisfactory response to treatment with metronidazole supports this hypothesis.…”

Pelvic ileo-anal reservoirs: a lectin histochemical study

“…The relative proportions of bacteria found were similar to those seen in normal faeces (Shepherd et al, 1989). A bacterial aetiology for pouchitis has been suggested because of its favourable response to metronidazole and other antibiotics (Kelly et al, 1983;O'Connell et aI., 1986;Luukonen et al, 1988). Studies have been carried out to determine whether there may be an identifiable bacterial pathogen, but no difference in types of bacteria present has been found between pouches with or without pouchitis (O'Connell et al, 1986;Luukonen et al, 1988;Madden eta]., 1990).…”

“…A bacterial aetiology for pouchitis has been suggested because of its favourable response to metronidazole and other antibiotics (Kelly et al, 1983;O'Connell et aI., 1986;Luukonen et al, 1988). Studies have been carried out to determine whether there may be an identifiable bacterial pathogen, but no difference in types of bacteria present has been found between pouches with or without pouchitis (O'Connell et al, 1986;Luukonen et al, 1988;Madden eta]., 1990). This suggests that the usefulness of metronidazole may reflect its immunosuppressive effect rather than its antibacterial activity (Scott & Phillips, 1989).…”

Probiotics and inflammatory bowel disease

“…[25][26][27] Some workers have reported an increase in anaerobes. 4,28 Work in this whole area is plagued by inconsistent findings. Studies are difficult to compare because culture methodologies differ, active and inactive disease are not always analysed separately, and drug use and disease localization are often not taken into account.…”