Distinct Microbiome in Pouchitis Compared to Healthy Pouches in Ulcerative Colitis and Familial Adenomatous Polyposis

Division of Pediatric Gastroenterology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Inflammatory Bowel Diseases (Impact Factor: 4.46). 05/2011; 17(5):1092-100. DOI: 10.1002/ibd.21460
Source: PubMed


Pouchitis occurs in up to 50% of patients with ulcerative colitis (UC) undergoing ileal pouch anal anastomosis (IPAA). Pouchitis rarely occurs in patients with familial adenomatous polyposis (FAP) who undergo IPAA. Our aim was to compare mucosal and luminal flora in patients with UC-associated pouchitis (UCP), healthy UC pouches (HUC), and healthy FAP pouches (FAP).
Nineteen patients were enrolled in this cross-sectional study (nine UCP, three HUC, seven FAP). Patients with active pouchitis were identified using the Pouchitis Disease Activity Index (PDAI). Ileal pouch mucosal biopsies and fecal samples were analyzed with a 16S rDNA-based terminal restriction fragment length polymorphism (TRFLP) approach. Pooled fecal DNA from four UCP and four FAP pouches were sequenced for further speciation.
TRFLP data revealed statistically significant differences in the mucosal and fecal microbiota between each group of patients. UCP samples exhibited significantly more TRFLP peaks matching Clostridium and Eubacterium genera compared to HUC and FAP pouches and fewer peaks matching Lactobacillus and Streptococcus genera compared to FAP. DNA Sanger sequencing of a subset of luminal samples revealed UCP having more identifiable sequences of Firmicutes (51.2% versus 21.2%) and Verrucomicrobia (20.2% versus 3.2%), and fewer Bacteroidetes (17.9% versus 60.5%) and Proteobacteria (9.8% versus 14.7%) compared to FAP.
The pouch microbial environment appears to be distinctly different in the settings of UC pouchitis, healthy UC, and FAP. These findings suggest that a dysbiosis may exist in pouchitis which may be central to understanding the disease.

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Available from: Christopher L Kitts
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    • "The intestinal tract of adult carries 1–2 kg of microbes. It is a common knowledge that pathogenic microbes could cause infectious diseases such as diarrheal, while others are associated with inflammatory and allergic diseases [1] [2] [3]. On the other hand, the majority of the gut microbes do protect us from pathogens via colonization resistance, modulation of immunity, and benefit us through digestion of foods and production of vitamins. "
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    • "At the phylum level, significantly decreased levels of Bacteroidetes and marginal increases in the Proteobacteria were associated with pouch outcome, among individuals with inflamed pouches compared to those without inflammation. This confirms results from other pouch studies, although results have been mixed in examining these organisms in the context of non-surgical IBD [12,27,28,29,30]. However, our study demonstrates that while Actinobacteria is detected in a majority of samples (72%), it is present at low abundance (mean 0.8%). "
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    • "In addition, the intestinal microbiota composition of colorectal cancer patients differs from that of healthy controls, however, no consistent pattern has yet been observed. The mucosal and faecal microbiota of UC pouchitis patients contained more Clostridium and Eubacterium and fewer Lactobacillus and Streptococcus genera compared with the microbiota of healthy pouches from familial adenomatous polyposis (FAP) patients (Lim et al. 2009; Zella et al. 2011 "
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