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[PMID]:28595172
[Au] Autor:Cai JX; Barrow J; Parian A; Brant SR; Dudley-Brown S; Efron J; Fang S; Gearhart S; Marohn M; Safar B; Truta B; Wick E; Lazarev M
[Ad] Endereço:Department of Medicine, Division of Gastroenterology and Hepatology, Meyerhoff Inflammatory Bowel Disease Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
[Ti] Título:Routine Pouchoscopy Prior to Ileostomy Takedown May Not Be Necessary in Patients with Chronic Ulcerative Colitis.
[So] Source:Dig Dis;36(1):72-77, 2018.
[Is] ISSN:1421-9875
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Creation of a J pouch is the gold standard surgical intervention in the treatment of chronic ulcerative colitis (UC). Pouchoscopy prior to ileostomy takedown is commonly performed. We describe the frequency, indication, and findings on pouchoscopy, and determine if pouchoscopy affects rates of complications after takedown. METHODS: All UC or indeterminate inflammatory bowel disease patients with a J pouch were retrospectively evaluated from January 1994 to December 2014. Cases were defined as having routine (asymptomatic) pouchoscopy after pouch creation but before ileostomy takedown. Controls were defined as having no pouchoscopy or pouchoscopy on the same day as that of takedown. RESULTS: The study included 178 patients (81.5% cases, 18.5% controls). Fifty two percent of pouchoscopies were reported as normal. Common abnormal endoscopy findings included stricture (35%), pouchitis (7%), and cuffitis (0.7%). Length of stay during takedown hospitalization was shorter for cases than controls (3 vs. 5 days; p = 0.001), but neither short- nor long-term complications were statistically different between cases and controls. Abnormalities on pouchoscopy were not predictive for short-term complications (p = 0.73) or long-term complications (p = 0.55). Routine pouchoscopy did not delay takedown surgery in any of the included patients. CONCLUSIONS: Routine pouchoscopy may not be necessary prior to ileostomy takedown; its greatest utility is in patients with suspected pouch complications.
[Mh] Termos MeSH primário: Colite Ulcerativa/cirurgia
Bolsas Cólicas
Endoscopia
Ileostomia
[Mh] Termos MeSH secundário: Adulto
Idoso
Doença Crônica
Colite Ulcerativa/complicações
Constrição Patológica/cirurgia
Feminino
Seres Humanos
Doenças Inflamatórias Intestinais/complicações
Masculino
Meia-Idade
Complicações Pós-Operatórias/etiologia
Pouchite/cirurgia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170609
[St] Status:MEDLINE
[do] DOI:10.1159/000475808


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[PMID]:29391089
[Au] Autor:Pandrangi V; Mandel D; Gellada N; Mieses D; Kallman C; Zaghiyan K; Fleshner P
[Ad] Endereço:Divisions of Colon and Rectal Surgery and Diagnostic Radiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
[Ti] Título:Abdominal Visceral Fat Area and Chronic Pouchitis after Ileal Pouch-Anal Anastomosis.
[So] Source:Am Surg;83(10):1029-1032, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Chronic pouchitis (CP) after ileal pouch-anal anastomosis is a significant clinical problem. Adipose tissues produce antiinflammatory cytokines and chemokines. We evaluated the association between abdominal visceral fat area (VFA) and CP. Patients with a preoperative CT evaluation were included. The diagnosis of CP was confirmed in all cases by endoscopy with afferent ileal limb intubation. Patients were allocated into groups of high VFA and low VFA. The study cohort of 52 patients had a median body mass index of 22 (range, 14-32). Indications for surgery were medically refractory disease in 46 (88%) patients and cancer/dysplasia in six (12%) patients. Median VFA was 27.1 (range, 1-144). Six (12%) patients developed CP. Low VFA patients were significantly younger (29 vs 45 years; P < 0.0001), had lower body mass index (20.4 vs 24.7; P < 0.0001), had surgery more commonly for medically refractory disease than for cancer or dysplasia (100 vs 77%; P = 0.02), and had a higher incidence of CP than high VFA patients (23 vs 0%; P = 0.02). Multiple linear regression analysis demonstrated that only low VFA was associated with CP (P = 0.009). An association is present between VFA and CP after ileal pouch-anal anastomosis, implicating adipocytes in the pathogenesis of inflammatory bowel disease.
[Mh] Termos MeSH primário: Adiposidade
Gordura Intra-Abdominal/anatomia & histologia
Complicações Pós-Operatórias/etiologia
Pouchite/etiologia
Proctocolectomia Restauradora
[Mh] Termos MeSH secundário: Adulto
Doença Crônica
Feminino
Seguimentos
Seres Humanos
Incidência
Gordura Intra-Abdominal/diagnóstico por imagem
Modelos Lineares
Masculino
Meia-Idade
Complicações Pós-Operatórias/epidemiologia
Pouchite/epidemiologia
Estudos Retrospectivos
Fatores de Risco
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


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[PMID]:28982899
[Au] Autor:Kawahara H; Akiba T; Yanaga K
[Ad] Endereço:Department of Surgery, Kashiwa Hospital, Jikei University School of Medicine, Chiba, Japan kawahide@jikei.ac.jp.
[Ti] Título:Transanal Assisted Resection with Closure of Anal Canal for Lower Rectal Diseases.
[So] Source:Anticancer Res;37(10):5767-5769, 2017 10.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/AIM: Abdominoperineal resection (APR) has been performed for lower rectal cancer, anal cancer and inflammatory diseases, but is associated with postoperative complications such as inflammation of pelvic dead space or perineal wound infection. We are performing a novel procedure (transanal assisted resection with closure of anal canal, TARC) that resects the intestine by using transanal assist and close the anal canal for patients who do not require resection of the anus and anal canal. PATIENTS AND METHODS: From January 2015 to March 2017, nine patients (seven males, two females) underwent this procedure in our hospital for rectal cancer, recurrent rectal cancer, postoperative refractory pouchitis, and cervical cancer invaded to the rectum. The three patients diagnosed with rectal cancer underwent this procedure by a completely laparoscopic abdominal approach. RESULTS: None developed postoperative dead space inflammation or perineal wound infections. CONCLUSION: TARC seems to allow improved postoperative quality of life as compared to APR.
[Mh] Termos MeSH primário: Canal Anal/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Laparoscopia
Recidiva Local de Neoplasia
Pouchite/cirurgia
Neoplasias Retais/cirurgia
Neoplasias do Colo do Útero/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Feminino
Seres Humanos
Laparoscopia/efeitos adversos
Masculino
Meia-Idade
Invasividade Neoplásica
Complicações Pós-Operatórias/etiologia
Pouchite/diagnóstico
Pouchite/etiologia
Qualidade de Vida
Neoplasias Retais/patologia
Resultado do Tratamento
Neoplasias do Colo do Útero/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE


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[PMID]:28670932
[Au] Autor:Jairath V; Khanna R; Feagan BG
[Ad] Endereço:a Robarts Clinical Trials Inc. , University of Western Ontario , London , Ontario , Canada.
[Ti] Título:Alicaforsen for the treatment of inflammatory bowel disease.
[So] Source:Expert Opin Investig Drugs;26(8):991-997, 2017 Aug.
[Is] ISSN:1744-7658
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Intracellular adhesion molecule-1 (ICAM-1), is a transmembrane glycoprotein of the immunoglobulin family, constitutively expressed on vascular endothelial cells and upregulated in inflamed colonic tissue. Alicaforsen, a 20 base ICAM-1 anti-sense oligonucleotide and highly selective ICAM-1 inhibitor, down-regulates ICAM-1 mRNA. Areas covered: We review mechanism of action, pharmacokinetics, pre-clinical, clinical and safety data of alicaforsen for the treatment of ulcerative colitis (UC), pouchitis and Crohn's disease (CD). Expert opinion: After 6 weeks of treatment, topical alicaforsen was significantly more effective than placebo in inducing remission in patients with moderate-severe distal UC, with treatment effects lasting up to 30 weeks. No difference was observed in head-head comparison with mesalamine topical enema, although alicaforsen appeared to have more durable treatment effect. Clinical trials of an intravenous formulation in Crohn's disease showed no significant treatment effect compared to placebo. An open-label trial in alicaforsen for pouchitis demonstrated encouraging results, now being assessed in a multi-national phase 3 trial. No major safety signals have been observed in UC patients treated with alicaforsen enemas. The potential as a novel therapy for pouchitis has led to orphan designation for this indication by the FDA and European Medicines Agency.
[Mh] Termos MeSH primário: Fármacos Gastrointestinais/uso terapêutico
Molécula 1 de Adesão Intercelular/efeitos dos fármacos
Oligonucleotídeos Fosforotioatos/uso terapêutico
[Mh] Termos MeSH secundário: Animais
Colite Ulcerativa/tratamento farmacológico
Colite Ulcerativa/fisiopatologia
Doença de Crohn/tratamento farmacológico
Doença de Crohn/fisiopatologia
Fármacos Gastrointestinais/efeitos adversos
Fármacos Gastrointestinais/farmacologia
Seres Humanos
Molécula 1 de Adesão Intercelular/genética
Oligonucleotídeos Fosforotioatos/efeitos adversos
Oligonucleotídeos Fosforotioatos/farmacologia
Pouchite/tratamento farmacológico
Pouchite/fisiopatologia
RNA Mensageiro/metabolismo
Indução de Remissão
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Gastrointestinal Agents); 0 (Phosphorothioate Oligonucleotides); 0 (RNA, Messenger); 126547-89-5 (Intercellular Adhesion Molecule-1); J8435V445B (alicaforsen)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170704
[St] Status:MEDLINE
[do] DOI:10.1080/13543784.2017.1349753


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[PMID]:28110377
[Au] Autor:Scaioli E; Sartini A; Liverani E; Digby RJ; Ugolini G; Rosati G; Poggioli G; Festi D; Bazzoli F; Belluzzi A
[Ad] Endereço:Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
[Ti] Título:Sulfasalazine in Prevention of Pouchitis After Proctocolectomy with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis.
[So] Source:Dig Dis Sci;62(4):1016-1024, 2017 Apr.
[Is] ISSN:1573-2568
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pouchitis is the most frequent complication after ileal pouch-anal anastomosis for refractory ulcerative colitis. A non-standardized preventative treatment exists. Sulfasalazine has proved effective in acute pouchitis therapy. AIMS: The aim of this study was to retrospectively evaluate the effect of sulfasalazine in primary prophylaxis of pouchitis after proctocolectomy with ileal pouch-anal anastomosis. METHODS: Data files of patients who underwent total proctocolectomy with ileal pouch-anal anastomosis for refractory ulcerative colitis and/or dysplasia from January 2007 to December 2014, with a follow-up until August 2015, were analyzed. After closure of loop ileostomy, on a voluntary basis, patients received a primary prophylaxis of pouchitis with sulfasalazine (2000 mg per day) continually until acute pouchitis flare and/or drop out due to side effects. RESULTS: Follow-up data were available for 51 of the 55 surgical patients. Median follow-up time was 68 months (range 10-104). Thirty postoperative complications occurred in 25 patients. 45% of patients developed pouchitis. Sulfasalazine prophylaxis was administered in 39.2% of patients; 15% of the these developed pouchitis versus 64.5% (20/31) of the non-sulfasalazine patients (p < 0.001). Pouchitis-free survival curves were 90.55 months in sulfasalazine patients and 44.46 in non-sulfasalazine patients (log-rank test p = 0.001, Breslow p = 0.001). CONCLUSION: Sulfasalazine may be potentially administered in pouchitis prophylaxis after proctocolectomy with ileal pouch-anal anastomosis, but large prospectively controlled trials are needed.
[Mh] Termos MeSH primário: Canal Anal/cirurgia
Colite Ulcerativa/cirurgia
Bolsas Cólicas/efeitos adversos
Pouchite/prevenção & controle
Proctocolectomia Restauradora/efeitos adversos
Sulfassalazina/uso terapêutico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Anastomose Cirúrgica/efeitos adversos
Anastomose Cirúrgica/tendências
Bolsas Cólicas/tendências
Feminino
Seguimentos
Fármacos Gastrointestinais/uso terapêutico
Seres Humanos
Masculino
Meia-Idade
Pouchite/etiologia
Proctocolectomia Restauradora/tendências
Estudos Prospectivos
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Gastrointestinal Agents); 3XC8GUZ6CB (Sulfasalazine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170123
[St] Status:MEDLINE
[do] DOI:10.1007/s10620-017-4454-9


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[PMID]:28008631
[Au] Autor:Segal JP; Ding NS; Worley G; Mclaughlin S; Preston S; Faiz OD; Clark SK; Hart AL
[Ad] Endereço:St. Mark's Hospital, Harrow, UK.
[Ti] Título:Systematic review with meta-analysis: the management of chronic refractory pouchitis with an evidence-based treatment algorithm.
[So] Source:Aliment Pharmacol Ther;45(5):581-592, 2017 Mar.
[Is] ISSN:1365-2036
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is considered the procedure of choice in patients with ulcerative colitis (UC) refractory to medical therapy. The incidence of pouchitis is 40% at 5 years. Ten to 15% of patients with pouchitis experience chronic pouchitis. AIM: To determine the efficacy of medical therapies for the treatment of chronic refractory pouchitis in patients undergoing IPAA for UC. METHODS: A systematic computer-assisted search of the on-line bibliographic database MEDLINE and EMBASE was performed between 1966 and February 2016. All original studies reporting remission rates following medical treatment for chronic pouchitis were included. All study designs were considered. Remission was defined according to the individual study. Remission endpoints ranged from 15 days to 10 weeks. Chronic pouchitis was defined by each study. RESULTS: Twenty-one papers were considered eligible. Results from all studies combined suggested that overall remission was obtained in 59% of patients (95% CI: 44-73%). Antibiotics significantly induced remission in patients with chronic pouchitis with 74% remission rate (95% CI:56-93%), (P < 0.001). Biologics significantly induced remission in patients with chronic pouchitis with 53% remission rate (95% CI:30-76%), (P < 0.001). Steroids, bismuth, elemental diet and tacrolimus all can induce remission but failed to achieve significance. Faecal microbiota transplantation in a single study was not found to achieve remission. CONCLUSIONS: Treatment of chronic refractory pouchitis remains difficult and is largely empirical. Larger randomised controlled trials will help aid the management of chronic pouchitis.
[Mh] Termos MeSH primário: Colite Ulcerativa/cirurgia
Pouchite/terapia
Proctocolectomia Restauradora/efeitos adversos
[Mh] Termos MeSH secundário: Algoritmos
Canal Anal/cirurgia
Bolsas Cólicas
Seres Humanos
Pouchite/etiologia
Indução de Remissão
Tacrolimo/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
WM0HAQ4WNM (Tacrolimus)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170815
[Lr] Data última revisão:
170815
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161224
[St] Status:MEDLINE
[do] DOI:10.1111/apt.13905


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[PMID]:27988458
[Au] Autor:Gao S; Wu X; Zhang Y; Li K; Wang L; Liu G
[Ad] Endereço:Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
[Ti] Título:Tripterygium wilfordii polyglycosidium ameliorates pouchitis induced by dextran sulfate sodium in rats.
[So] Source:Int Immunopharmacol;43:108-115, 2017 Feb.
[Is] ISSN:1878-1705
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The aim of this study was to investigate the therapeutic effects of Tripterygium wilfordii polyglycosidium (TWP) to rats with dextran sulfate sodium (DSS)-induced pouchitis and its possible mechanism. METHODS: Sprague-Dawley rats underwent surgery of ileal pouch anal anastomosis (IPAA) and pouchitis was induced by DSS. Rats were randomly divided into no intervention (NI), normal saline (NS) and TWP groups. Rats were lavaged with normal saline (3ml/day in NS group) or TWP (12mg/kg/day in TWP group) for 7days. General conditions of animals and histopathological examinations were evaluated. Interleukin (IL)-1ß, IL-6, IL-10, and tumor necrosis factor (TNF)-α mRNA expression was measured. Levels of occludin and Zo-1 proteins were measured by immunohistochemistry. In addition, ALT and AST were assessed. RESULTS: TWP significantly attenuated the symptoms of pouchitis characterized by body weight loss, diarrhea, and bloody stool. Furthermore, TWP diminished histological damage compared with other groups. There was a significant reduction in levels of IL-1ß, IL-6, and TNF-α, as well as an increase in IL-10 in the TWP group. The expression of tight junction proteins occludin and Zo-1 were increased in the TWP group. There were no statistical differences in serum ALT and AST among the three groups. CONCLUSIONS: TWP significantly ameliorated pouchitis and inhibited the production of IL-1ß, IL-6, and TNF-α as well as increased the levels of IL-10, occludin, and Zo-1 protein in rats. These findings suggest TWP might be a potential therapeutic agent for patients with pouchitis.
[Mh] Termos MeSH primário: Anti-Inflamatórios/uso terapêutico
Diterpenos/uso terapêutico
Mucosa Intestinal/efeitos dos fármacos
Fenantrenos/uso terapêutico
Pouchite/tratamento farmacológico
Tripterygium/imunologia
[Mh] Termos MeSH secundário: Animais
Citocinas/metabolismo
Sulfato de Dextrana
Modelos Animais de Doenças
Compostos de Epóxi/uso terapêutico
Seres Humanos
Íleo/cirurgia
Mucosa Intestinal/patologia
Masculino
Ocludina/metabolismo
Pouchite/induzido quimicamente
Ratos
Ratos Sprague-Dawley
Proteína da Zônula de Oclusão-1/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents); 0 (Cytokines); 0 (Diterpenes); 0 (Epoxy Compounds); 0 (Occludin); 0 (Phenanthrenes); 0 (Tjp1 protein, mouse); 0 (Zonula Occludens-1 Protein); 19ALD1S53J (triptolide); 9042-14-2 (Dextran Sulfate)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170411
[Lr] Data última revisão:
170411
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161219
[St] Status:MEDLINE


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[PMID]:27769810
[Au] Autor:Sartor RB; Wu GD
[Ad] Endereço:Departments of Medicine, Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: rbs@med.unc.edu.
[Ti] Título:Roles for Intestinal Bacteria, Viruses, and Fungi in Pathogenesis of Inflammatory Bowel Diseases and Therapeutic Approaches.
[So] Source:Gastroenterology;152(2):327-339.e4, 2017 Feb.
[Is] ISSN:1528-0012
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Intestinal microbiota are involved in the pathogenesis of Crohn's disease, ulcerative colitis, and pouchitis. We review the mechanisms by which these gut bacteria, fungi, and viruses mediate mucosal homeostasis via their composite genes (metagenome) and metabolic products (metabolome). We explain how alterations to their profiles and functions under conditions of dysbiosis contribute to inflammation and effector immune responses that mediate inflammatory bowel diseases (IBD) in humans and enterocolitis in mice. It could be possible to engineer the intestinal environment by modifying the microbiota community structure or function to treat patients with IBD-either with individual agents, via dietary management, or as adjuncts to immunosuppressive drugs. We summarize the latest information on therapeutic use of fecal microbial transplantation and propose improved strategies to selectively normalize the dysbiotic microbiome in personalized approaches to treatment.
[Mh] Termos MeSH primário: Disbiose/microbiologia
Microbioma Gastrointestinal/genética
Doenças Inflamatórias Intestinais/microbiologia
[Mh] Termos MeSH secundário: Animais
Bactérias/genética
Bactérias/metabolismo
Colite Ulcerativa/metabolismo
Colite Ulcerativa/microbiologia
Doença de Crohn/metabolismo
Doença de Crohn/microbiologia
Disbiose/metabolismo
Fungos/genética
Fungos/metabolismo
Seres Humanos
Doenças Inflamatórias Intestinais/metabolismo
Metaboloma
Metagenoma
Pouchite/metabolismo
Pouchite/microbiologia
Vírus/genética
Vírus/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE


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[PMID]:27613294
[Au] Autor:Maharshak N; Cohen NA; Reshef L; Tulchinsky H; Gophna U; Dotan I
[Ad] Endereço:Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
[Ti] Título:Alterations of Enteric Microbiota in Patients with a Normal Ileal Pouch Are Predictive of Pouchitis.
[So] Source:J Crohns Colitis;11(3):314-320, 2017 Mar 01.
[Is] ISSN:1876-4479
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: To examine whether patients with a mature normal pouch [> 1 year post ileostomy closure] have microbial stool characteristics that can predict pouch inflammation. Design: Patients undergoing pouch surgery were recruited prospectively. Microbiota analysis of faecal samples was by 16S rRNA gene pyrosequencing. All patients had a normal pouch at baseline [T1]. Those without pouchitis during the first year of follow-up [T2] comprised the 'Normal Pouch-sustained' group and those who had experienced an episode of pouchitis comprised the 'Pre-Pouchitis' group. Results: Twenty patients were recruited (age 53.6±13.1 years, pouch age [time from ileostomy closure] 8.1±5.1 years). Seven patients developed pouchitis during follow-up [within 265±93.6 days] and they were assigned to the Pre-Pouchitis group at T1: they had a decreased microbial diversity at T1 compared with the Normal Pouch-sustained patients [n = 13]. The Shannon diversity index for the Pre-Pouchitis patients was 3.4 vs 4.23 for the Normal Pouch-sustained patients [p = 0.011]. There were no substantial group differences in high taxonomic levels [order or above]. The genus Ruminococcus was significantly decreased in the Pre-Pouchitis patients' samples compared with those of the Normal Pouch-sustained patients (0.19% vs 0.78%, respectively, false discovery rate [FDR] = 0.05). The linear discriminant analysis with effect size estimation algorithm revealed that Lachnospira and Coprococcus genera were also decreased among Pre-Pouchitis patients compared with Normal Pouch-sustained patients [0.6% vs 1.95% and 2.1% vs 4%, respectively]. Conclusions: Patients with a normal mature pouch may be predisposed to acute pouchitis when faecal microbial diversity and certain microbial groups are decreased. These findings may aid in risk stratification of those patients.
[Mh] Termos MeSH primário: Disbiose/complicações
Fezes/microbiologia
Microbioma Gastrointestinal
Pouchite/microbiologia
RNA Ribossômico 16S/análise
[Mh] Termos MeSH secundário: Adulto
Idoso
Clostridiales/isolamento & purificação
Bolsas Cólicas
Disbiose/microbiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Fatores de Risco
Ruminococcus/isolamento & purificação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (RNA, Ribosomal, 16S)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160911
[St] Status:MEDLINE
[do] DOI:10.1093/ecco-jcc/jjw157


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[PMID]:26423113
[Au] Autor:Machiels K; Sabino J; Vandermosten L; Joossens M; Arijs I; de Bruyn M; Eeckhaut V; Van Assche G; Ferrante M; Verhaegen J; Van Steen K; Van Immerseel F; Huys G; Verbeke K; Wolthuis A; de Buck Van Overstraeten A; D'Hoore A; Rutgeerts P; Vermeire S
[Ad] Endereço:Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospital Leuven, KU Leuven, Leuven, Belgium.
[Ti] Título:Specific members of the predominant gut microbiota predict pouchitis following colectomy and IPAA in UC.
[So] Source:Gut;66(1):79-88, 2017 Jan.
[Is] ISSN:1468-3288
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Pouchitis is the most common complication after colectomy with ileal pouch-anal anastomosis (IPAA) for UC and the risk is the highest within the 1st year after surgery. The pathogenesis is not completely understood but clinical response to antibiotics suggests a role for gut microbiota. We hypothesised that the risk for pouchitis can be predicted based on the faecal microbial composition before colectomy. DESIGN: Faecal samples from 21 patients with UC undergoing IPAA were prospectively collected before colectomy and at predefined clinical visits at 1 month, 3 months, 6 months and 12 months after IPAA. The predominant microbiota was analysed using community profiling with denaturing gradient gel electrophoresis followed by quantitative real-time PCR validation. RESULTS: Cluster analysis before colectomy distinguished patients with pouchitis from those with normal pouch during the 1st year of follow-up. In patients developing pouchitis, an increase of Ruminococcus gnavus (p<0.001), Bacteroides vulgatus (p=0.043), Clostridium perfringens (p=0.011) and a reduction of two Lachnospiraceae genera (Blautia (p=0.04), Roseburia (p=0.008)) was observed. A score combining these five bacterial risk factors was calculated and presence of at least two risk factors showed a sensitivity and specificity of 100% and 63.6%, respectively. CONCLUSIONS: Presence of R. gnavus, B. vulgatus and C. perfringens and absence of Blautia and Roseburia in faecal samples of patients with UC before surgery is associated with a higher risk of pouchitis after IPAA. Our findings suggest new predictive and therapeutic strategies in patients undergoing colectomy with IPAA.
[Mh] Termos MeSH primário: Colite Ulcerativa/microbiologia
Colite Ulcerativa/cirurgia
DNA Bacteriano/análise
Fezes/microbiologia
Pouchite/microbiologia
[Mh] Termos MeSH secundário: Adulto
Bacteroidetes/genética
Bacteroidetes/isolamento & purificação
Clostridium perfringens/genética
Clostridium perfringens/isolamento & purificação
Análise por Conglomerados
Bolsas Cólicas/efeitos adversos
Ácidos Graxos Voláteis/análise
Fezes/química
Feminino
Microbioma Gastrointestinal/genética
Seres Humanos
Complexo Antígeno L1 Leucocitário/análise
Masculino
Meia-Idade
Valor Preditivo dos Testes
Período Pré-Operatório
Proctocolectomia Restauradora/efeitos adversos
Estudos Prospectivos
Ruminococcus/genética
Ruminococcus/isolamento & purificação
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (DNA, Bacterial); 0 (Fatty Acids, Volatile); 0 (Leukocyte L1 Antigen Complex)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:151002
[St] Status:MEDLINE
[do] DOI:10.1136/gutjnl-2015-309398



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