The bacterial pathogenesis and treatment of pouchitis

Abstract

Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis is the operation of choice for patients with ulcerative colitis. Pouchitis is the most common cause of pouch dysfunction. Although the pathogenesis of this disease is not well understood, bacteria have been implicated in the disease process. Numerous bacterial studies have been reported over the last 25 years with few unifying findings. In addition, many different treatments for pouchitis have been reported with varying results. Antibiotic treatment remains the most studied and is the mainstay of treatment. In this article we review the aetiology of pouchitis and the evidenced-based treatment options.

Mucosa-Associated Faecalibacterium prausnitzii Phylotype Richness Is Reduced in Patients with Inflammatory Bowel Disease

“…The firmicute Faecalibacterium prausnitzii (Ruminococcaceae) is one of the three most abundant species, representing approximately 6 to 8% of the gut microbial community in healthy subjects, although it can reach up to 20% in some individuals (1,(4)(5)(6)(7)(8)(9)(10)(11). In contrast, depletion of F. prausnitzii has been reported to occur in several pathological disorders (for a review, see reference 12 and references therein), such as Crohn's disease (CD) (12-19), ulcerative colitis (UC) (11,14,15,17,(20)(21)(22)(23)(24)(25)(26), irritable bowel syndrome (IBS) of alternating type (27), colorectal cancer (CRC) (28, 29), and diabetes (30-32).Many studies have shown the potential role of F. prausnitzii in promoting gut health through the secretion of anti-inflammatory compounds, such as butyrate (16,(33)(34)(35)(36), and in reducing the severity of colitis induced in mice (16,37). Despite being a relatively abundant bacterium capable of regulating gut homeostasis (38, 39) and interacting in several host pathways (40), few studies have paid attention to the distribution of phylotypes within Faecalibacterium populations in the human gut.…”

“…The firmicute Faecalibacterium prausnitzii (Ruminococcaceae) is one of the three most abundant species, representing approximately 6 to 8% of the gut microbial community in healthy subjects, although it can reach up to 20% in some individuals (1,(4)(5)(6)(7)(8)(9)(10)(11). In contrast, depletion of F. prausnitzii has been reported to occur in several pathological disorders (for a review, see reference 12 and references therein), such as Crohn's disease (CD) (12-19), ulcerative colitis (UC) (11,14,15,17,(20)(21)(22)(23)(24)(25)(26), irritable bowel syndrome (IBS) of alternating type (27), colorectal cancer (CRC) (28, 29), and diabetes (30-32).…”

Pediatric surgery and the human microbiome

“…The importance of gut microbes in pouchitis is supported by the efficacy of antimicrobial therapy in most cases. Several studies, thus far, have used molecular approaches to compare gut microbes in UC patients with and without pouchitis; generally, these studies have demonstrated a decrease in bacterial diversity in patients with pouchitis but have not identified reproducible changes in community membership [93,94]. Although the pathogenesis of the condition remains uncertain, results from a handful of trials indicate that probiotics should be seriously considered for the prevention and/or treatment of pouchitis.…”

“…A small but randomized study in 2003 reported that daily administration of VSL#3 for 1 year after ileostomy closure in patients with UC significantly reduced the incidence of pouchitis after proctocolectomy relative to placebo [95]. It was subsequently shown that combination therapy with broad-spectrum antibiotics, followed by administration of VSL#3, successfully induced and maintained remission in patients with pouchitis [94]. Results from a more recent human trial also demonstrated a reduction in the pouchitis disease activity index after treatment with VSL#3, and the authors of this report provided evidence that the mechanism of action of probiotics in the setting of UC involves expansion of regulatory lymphocytes within the pouch mucosa [96].…”

Commensal bacteria

“…Summary It makes sense, given the size and complexity of the microbiota and its role in homeostasis, that the microbiota and its interactions with the host would play a role in the pathogenesis of IBS and IBD; sorting out the details has proven challenging but does offer new therapeutic avenues for both disorders. the clinical observation that pouchitis could be readily cleared by the use of antibiotics alone and remission maintained with a probiotic cocktail [6] presented a clear clinical scenario in which these interactions were clearly operative.…”