Assessment of mucosal inflammation and blood flow in response to four weeks' intervention with probiotics in patients operated with a J-Configurated ileal-pouch-anal-anastomosis (IPAA)
| Autor: | Arne Bakka, Lars Aabakken, A B Hvinden, J Eide, Geir Aamodt, A Røset, Morten H. Vatn, A Bjørneklett, K O Laake, Pål-Dag Line, Krzysztof Grzyb |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male medicine.medical_specialty Colonic Pouches Pouchitis Severity of Illness Index Gastroenterology Drug Administration Schedule Familial adenomatous polyposis Feces Internal medicine Laser-Doppler Flowmetry medicine Humans Colitis integumentary system medicine.diagnostic_test business.industry Probiotics Blood flow Middle Aged medicine.disease Ulcerative colitis Endoscopy Lactobacillus Regional Blood Flow Colitis Ulcerative Female Bifidobacterium Pouch business Leukocyte L1 Antigen Complex Perfusion |
| Zdroj: | Scandinavian Journal of Gastroenterology. 39:1228-1235 |
| ISSN: | 1502-7708 0036-5521 |
| DOI: | 10.1080/00365520410009320 |
| Popis: | Pouchitis is a common and troublesome condition in patients operated on with ileal-pouch-anal-anastomosis (IPAA). A disturbed mucosal perfusion in the pouch has been suggested as a possible cause. Laser Doppler flowmetry (LDF) has been used successfully to measure gastric and colonic mucosal perfusion in humans. In a previous study, we demonstrated a reduced mucosal perfusion in the distal part of the pouch, during probiotic intervention, examined by LDF measurement. The aim of the present study was to confirm our previous results in a much larger material, and to compare the results of LDF measurements and inflammatory activity in ulcerative colitis (UC) patients with those in familial adenomatous polyposis (FAP) patients.Five hundred millilitres of a fermented milk product (Cultura), containing live lactobacilli (La-5) and bifidobacteria (Bb-12), was given daily for 4 weeks to 41 UC and 10 patients with FAP, operated on with IPAA. Mucosal perfusion was measured with LDF and the degree of inflammation was examined at predefined levels of the distal bowel by histology and faecal calprotectin measurements both before and after intervention. We also evaluated the applicability of a Pouchitis Disease Activity Index (PDAI).The LDF measurements were reproducible in the pelvic pouch at each of the predefined levels, but did not change during intervention. Mucosal perfusion was significantly reduced in the distal compared to the proximal part of the pouch in the UC group (P0.05). The perfusion levels were higher in the FAP patients compared to the UC patientsat all predefined levels (P0.05). Calprotectin levels and histological score did not change significantlyafter intervention in any of the groups. The calprotectin level was significantly lower in the FAP compared to the UC group both before and after intervention. The PDAI decreased in both groups from alevel considered diagnostic for pouchitis to a level considered as not active pouchitis. The decreasewas significant for the UC patients.The results did not demonstrate an effect of probiotics on histology, although a significant effect on the PDAI was achieved, which concurs with the previously reported effect on symptoms and endoscopic score. The significantly reduced blood flow in the UC group compared to the FAP group, operated on with the same procedure, and the significantly increased calprotectin levels in the UC group, are original findings. Both findings may be related to an increased risk for pouchitis among UC patients. The lack of effect of intervention on mucosal perfusion does not exclude a role for reduced circulation as a cause of pouchitis based on the reduced LDF measurements in the distal part of the pouch. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|