How do you treat this diversion ileitis and pouchitis?

Tominaga, Kentaro; Tsuchiya, Atsunori; Yokoyama, Junji; Terai, Shuji

doi:10.1136/gutjnl-2017-315591

Cited by 13 publications

(20 citation statements)

References 4 publications

(2 reference statements)

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“…Selvig et al [7] also report statistically significant improvement in bowel frequency, which was particularly evident in patients receiving rifaximin pre-FMT and a second FMT instillation. These observations align well with a recent report of severe diversion ileitis and pouchitis in a patient with a history of ulcerative pancolitis, in whom multiple autologous FMT infusions were required for successful treatment, leading to an increase in Firmicutes and decrease in Proteobacteria in the ileal pouch [8].…”

supporting

confidence: 91%

Promise of Fecal Microbiota Transplantation Therapy in Pouchitis

2019

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supporting

confidence: 91%

Promise of Fecal Microbiota Transplantation Therapy in Pouchitis

2019

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“…After reviewing the title and abstract and, if necessary, the full publication, 388 records were rejected. After the reviewing process, a total of 37 publications met the inclusion criteria 11,18, : thirty-three full-text (89.2%) 11,18,23,51,54,56 and four abstracts (10.8%). 52,53,55,57 Figure 1 illustrates the selection process.…”

Section: Resultsmentioning

confidence: 99%

“…The study design was as follows: two randomized studies (5.4%), 30,46 four prospective studies (10.8%), 33,34,38,40 14 retrospective studies (37.9%), 18,24,25,36,39,42,44,50,[52][53][54][55][56][57] and 17 case reports/series (45.9%). 23,26,29,31,32,35,37,41,43,45,47,49,51,56 Two papers were written in French 34,35 and one in German, 28 all remaining papers were written in English. Table 1 presents all the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…27 Tominaga et al detected a decreased relative concentration of Firmicutes and increased Proteobacteria in the ileal pouch affected by diversion pouchitis of an UC patient. 51 Additionally, a sustained high rate of cellular proliferation in CD patients with exclusion of the fecal stream can be observed. 33 This hyper-proliferation contrasts with the diversion-induced hypoplasia of non-IBD controls.…”

Section: Incidence and Pathogenesis Of Dp In Ibdmentioning

confidence: 99%

“…24,28,31,33 Four studies reported possible pathogenetic factors of DP. 27,34,46,51 The colonic epithelium is damaged due to a deficiency of nutrients derived from the anaerobic bacterial fermentation of starch and proteins by the flora, such as short-chain fatty acids (SCFAs), above all, butyric acid. 46 The lack of oxidative substrates prompts inflammation and damages cell tropism.…”

Section: Incidence and Pathogenesis Of Dp In Ibdmentioning

confidence: 99%

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Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel diseases: A systematic review

et al. 2021

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Background and aims: Diversion proctocolitis (DP) is a non-specific mucosal inflammation arising in the defunctionalized colon and/or rectum following faecal diversion (colostomy, ileostomy). Differential diagnosis of DP from the underlying disease in patients with inflammatory bowel diseases (IBD) is often unclear. As a result, it might be difficult to undertake any specific treatment. We aimed to systematically review the literature evidence on DP in IBD patients.Methods: For this qualitative systematic review, we searched PubMed, EMBASE and Scopus to identify all studies published until July 2021 including IBD patients affected by DP.Results: Overall, 37 papers published between 1982 and 2021 were included. A total of 1.211 IBD patients were included: 613 UC (50.6%), 524 CD (43.3%), 66 IBDunclassified (IBD-U) (5.4%), 8 unspecified patients (0.7%). Most patients with DP are asymptomatic, although inflammation is detectable in almost all patients with a rectal stump. Reduced short-chain fatty acids and an altered microbiome, may trigger mucosal inflammation and have been proposed as causing factors. An increased risk of developing cancer on DP has been reported in patients with a history of previous dysplasia/cancer. Conclusions:The etiopathogenesis of DP is still unknown. The efficacy of mesalamine, corticosteroids or short-chain fatty acids has not been proven by randomized trials yet. Since the incidence of cancer of the rectal stump can reach 4.5 per 1.000 diverted patients-year, IBD patients undergoing subtotal colectomy with end-ileostomy should undergo close endoscopic surveillance, being eventually counseled for surgery with or without the restoration of the intestinal continuity.

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Utility of autologous fecal microbiota transplantation and elucidation of microbiota in diversion colitis

et al. 2021

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Objectives Diversion colitis (DC) is an inflammatory disorder caused by interruption of the fecal stream and subsequent nutrient deficiency from luminal bacteria. The utility of fecal microbiota transplantation (FMT) for DC was recently investigated; however, the precise pathogenesis of this condition remains unclear. This study aimed to evaluate the utility of autologous FMT in DC and to determine the related changes in the intestinal microbiota. Methods Autologous FMT was performed to reestablish the intestinal microbiota in five patients (average age, 64.6 ± 8.3 years) with DC. They underwent double‐ended colostomy. We assessed the diverted colon by endoscopy and evaluated the microbiota before and after FMT using the 16S rRNA gene sequencing method. Results All five patients had mild inflammation (ulcerative colitis endoscopic index of severity [UCEIS] 2–3) in the diverted colon based on the colonoscopic findings. Three patients presented with symptoms, such as tenesmus, mucoid stool, and bloody stool. With FMT treatment, all patients achieved endoscopic remission (UCEIS score of 0 or 1) and symptomatic improvement. We observed a significantly decreased α‐diversity in DC patients compared to healthy controls. The frequency of aerobic bacteria, such as Enterobacteriaceae , in the diverted colon decreased after autologous FMT. Conclusions This study was the first to show that the microbiota in the diverted colon was significantly affected by autologous FMT. Since interruption of the fecal stream is central to the development of DC, FMT can be considered a promising treatment.

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How do you treat this diversion ileitis and pouchitis?

Cited by 13 publications

References 4 publications

Promise of Fecal Microbiota Transplantation Therapy in Pouchitis

Promise of Fecal Microbiota Transplantation Therapy in Pouchitis

Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel diseases: A systematic review

Utility of autologous fecal microbiota transplantation and elucidation of microbiota in diversion colitis

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