Pouchitis: lessons for inflammatory bowel disease

Abstract

Ileal pouch and pouchitis represent a valuable human model to study the evolution of bacterial communities and host-bacteria interactions in IBD by sequentially monitoring microbiological and immunological profile before, during, and after pouch construction and before and after development and treatment of pouchitis.

Degradation of the extracellular matrix components by bacterial-derived metalloproteases

“…A significant increase of C. perfringens has been found in patients with pouchitis following surgical creation of an ileoanal pouch in patients undergoing colectomy for UC, and this represents a valuable model for the study of host-bacteria interactions in IBD. [52][53][54] In addition to proteolytic activity, all of the C. perfringens isolated in this study exhibited strong mucinase activity, which may also contribute to the pathophysiology of IBD. Mucin depletion is characteristic of colitis, and the importance of this in relation to specific bacterial colonization and immunological responses in IBD has been addressed elsewhere.…”

Specific members of the predominant gut microbiota predict pouchitis following colectomy and IPAA in UC

“…Several risk factors for the development of pouchitis have been proposed. These include primary sclerosing cholangitis, extraintestinal manifestations, severe pancolitis, backwash ileitis, non-steroidal anti-inflammatory drug use, preoperative thrombocytosis, perinuclear antineutrophil cytoplasmic antibody and anti-CBir1 positivity, non-smoking, and genetic polymorphisms (interleukin-1 receptor antagonist (IL-1ra), tumor necrosis factor (TNF), Nucleotide-binding oligomerization domain 2 (NOD2), Toll-like receptor 1 (TLR1)) 2 5. The findings of many reported risk factors are however inconsistent.…”

Ileal pouch for everyone, even when we are not sure of the diagnosis before or at colectomy?

“…In addition, serum levels of pANCA and anti-CBir1 flagellin may be different in acute and chronic pouchitis. 2 Therefore, IC has not been consistently shown to be a risk factor for either acute or chronic pouchitis, based on the current literature. The results of Murrell et al's study supports the notion.…”