Microbial Colonization and Hepatic Abnormalities in Jejunoileal Bypass with Resection, Ileal Mucous Fistula, and Ileocolostomy

Abstract

A role for bacterial colonization of the intestines in the pathogenesis of hepatic abnormalities after jejunoileal bypass was sought. Dogs were divided into groups according to the disposition of the bypassed segment; resection (group I), exteriorization as an ileal mucous fistula (group II), and drainage via an ileocolonic anastomosis (group III). Weight loss, abnormalities in liver function, and hepatic steatosis were significantly greater in groups II and III than in group I. Concomitantly, there was a significant increase in the total number of bacterial colony-forming units in groups II and III. Moreover, a greater number of specific anaerobic genera was isolated in group III than in group II. It is concluded that: (1) retention of the bypassed intestinal segment is associated with greater changes in liver function and structure than when the segment is resected; (2) the changes in the liver correlated with bacterial proliferation in the bypassed intestinal segment; and (3) despite a greater number of anaerobic genera in the ileocolostomy than in the mucous fistula, both procedures were associated with hepatic abnormalities.

Anaerobic bacterial populations on normal and diseased human biopsy tissue obtained at colonoscopy

“…Roediger (16) suggested that the fatty acid byproducts of anaerobic bacterial metabolism are used as an energy source by colonocytes. Studies in our laboratory (5), involving the anaerobic flora colonizing bypassed bowel segments, demonstrated that mucosal bacteria within these excluded limbs increased several log fold without the advantage of a nutrient fecal stream. In essence the anaerobic microflora adherent to the mucosal surface may be both utilizing cellular debris for growth and, at the same time, contributing to the nutritional requirements of individual mucosal cells (17).…”

“…On the morning of the procedure the patients received a tap water enema. Of the 21 patients studied, 12 presented with colonic polyps, 5 had IBD, and four had carcinoma of the colon. None of the patients in the study received antibiotics before colonoscopy.…”

“…Bacte- FIG. 5. Mean value ± SE for the recovery of anaerobic genera (A) and species (B) from polyps, cancer, and IBD (open bars) and their respective adjacent normal mucosa (shaded bars).…”