Stasis Predisposes Ileal Pouch Inflammation in a Rat Model of Ileal Pouch-Anal Anastomosis

Stucchi, Arthur F.; Shebani, Khaled O.; Reed, Karen L.; Gower, Adam C.; Alapatt, Michael F.; Crivello, Keith; McClung, James P.; Becker, James M.

doi:10.1016/j.jss.2009.03.049

Cited by 11 publications

(13 citation statements)

References 50 publications

(63 reference statements)

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“…The strictured ileo-anal anastomosis was performed intraoperatively. The stricture is one of the causes of pouchitis both in clinical and experimental models [16][17][18]. After one day of fasting (exclusive supply of 8% glucose solution), the animals received a semi-synthetic diet without fiber (AIN-93) in increasing doses for ten days (respectively 5, 8, 10 and 12 g/d in the following days, up to 25 g/d) [19].…”

Section: Methodsmentioning

confidence: 99%

Discrepancy between clinical and histological effects of DHA supplementation in a rat model of pouchitis

Drzymała-Czyż

Banasiewicz

Tubacka

et al. 2012

Folia Histochem Cytobiol.

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Docosahexaenoic acid (DHA) potentially modulates inflammatory processes. Therefore, the aim of this study was to determine the influence of DHA supplementation on the expression of intestinal inflammation and nutritional status in rats which have undergone restorative proctocolectomy. Twenty-four Wistar rats were operated. After the induction of pouchitis, animals were randomly divided into a control group (CG) and supplementation groups receiving respectively a semi-synthetic diet without or with DHA (in a lower or higher dose, respectively known as the lower dose, LD, and higher dose, HD, groups) for six weeks. Selected nutritional parameters were assessed. Histopathological and immunohistochemical analysis of pouch mucosa specimens was also performed. The effectiveness of feeding and quality of stools were significantly better in the HD group than in the CG. The intensity of inflammation (Moskovitz scale) was higher in HD and LD than in CG (p = 0.03 and p = 0.0006, respectively). Nevertheless, pouch adaptation (Laumonier scale) was more significant in LD than in CG (p = 0.007). On the other hand, tissue expression of IL-1a and IL-10 was higher in HD and LD than in CG (IL-1a, p = 0.009 and p = 0.05, respectively; IL-10, p = 0.04 for both). DHA supplementation has no impact on body weight gain. Yet it seems that it may improve the effectiveness of nutrition and stool quality in rats which have undergone restorative proctocolectomy. Simultaneously, it increases the intensity of pouch adaptation and inflammation. The specificity of observed changes is not clear. However, it may imply potential modulation of inflammatory processes of pouch mucosa.

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Section: Methodsmentioning

confidence: 99%

Discrepancy between clinical and histological effects of DHA supplementation in a rat model of pouchitis

Drzymała-Czyż

Banasiewicz

Tubacka

et al. 2012

Folia Histochem Cytobiol.

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“…Colonic metaplasia occurs to some degree in all functioning ileal pouches, although it is rarely evident in pouch mucosa, either prior to ileostomy closure [35,36] or in the terminal ileum, of patients with a unobstructed ileostomy, suggesting that stasis may predispose these morphologic changes. In the Stucchi's study [34], there is biochemical evidence of neutrophil recruitment and elevated MPO levels to the ileal pouch of IPAA animals as early as 30 days postoperatively.…”

Section: Pathophysiologymentioning

confidence: 98%

“…Both of these mechanisms can compromise epithelial integrity and barrier function, thus predisposing the ileal pouch mucosa to a low-grade inflammatory response. Both anaerobic and aerobic bacteria overgrow the ileal pouch at 30 days postoperatively [33,34].…”

Section: Pathophysiologymentioning

confidence: 99%

“…As mentioned earlier, patients undergoing the same IPAA procedure for FAP rarely experience pouchitis even though ileal pouch stasis occurs, suggesting that the mechanisms initiating ileal pouch inflammation extend beyond bacteria alone. Based on this line of reasoning, one might expect that an animal model of IPAA that lacks either a genetic predisposition to colonic inflammation, such as the HLA-B27 rat, or an inflammatory bowel disease, would not develop spontaneous ileal pouch inflammation [34].…”

Section: Pathophysiologymentioning

confidence: 99%

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Surgical Prophylaxis of Pouchitis in Ulcerative Colitis

et al. 2010

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Ileal pouch-anal anastomosis (IPAA) is now the procedure of choice for most patients requiring proctocolectomy for ulcerative colitis. The J-shaped pouch, usually 15-20 cm in length, is easiest to construct and has functional outcomes identical to those of the more complex designs. IPAA is a complex procedure, and complications occur frequently. Despite the significant improvements this surgical advance has made on the quality of life in these patients, inflammation of the surgically created ileal pouch or pouchitis remains a major late postoperative complication that can often overshadow the benefits of this otherwise curative operation. Several inflammatory and noninflammatory complications can occur after IPAA. Pouchitis is the most common, occurring in ≈50% of patients. Whereas acute pouchitis can be treated rapidly and successfully in the majority of patients, refractory and chronic pouchitis remain therapeutic challenges to patients and physicians. The problem is believed to be caused by stasis of feces in the pouch with overgrowth of aerobic and anaerobic organisms. The size of the pouch has a significant influence on the incidence of pouchitis: a smaller pouch usually empties better than a larger pouch and so may be less susceptible to pouchitis.

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“…Stucchi and colleagues [8,9] and others [10] have made an important contribution to the IBD literature by developing an animal model with a J pouch after colectomy. This is of particular importance because the authors' model reproduces some features of early pouchitis.…”

mentioning

confidence: 99%

In Search of an Effective Animal Model To Study the Nemesis of the IBD Surgeon—Pouchitis after IPAA

Dayton

2010

Journal of Surgical Research

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Stasis Predisposes Ileal Pouch Inflammation in a Rat Model of Ileal Pouch-Anal Anastomosis

Cited by 11 publications

References 50 publications

Discrepancy between clinical and histological effects of DHA supplementation in a rat model of pouchitis

Discrepancy between clinical and histological effects of DHA supplementation in a rat model of pouchitis

Surgical Prophylaxis of Pouchitis in Ulcerative Colitis

In Search of an Effective Animal Model To Study the Nemesis of the IBD Surgeon—Pouchitis after IPAA

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