Abstract
Simple SummaryThe observations presented in this study conclude that the preoperative stimulation with probiotics of the efferent loop through the dysfunctional bowel, to allow the slow infusion, can have a reducing effect on the endoscopic and histopathological alterations of diversion colitis. This procedure may be an alternative treatment to resolve the inflammation in patients where the surgical option is not feasible or available.The use of a loop ileostomy as the defunctioning procedure of choice to protect a distal colonic anastomosis causes histological and endoscopic changes in the intestinal mucosal architecture, which have been related to chronic inflammation and changes in the microflora that consequently impact the intestinal structure and function following fecal stream diversion. The aim of this study was to evaluate the histological and endoscopic changes on the colonic mucosa in patients with diversion colitis after stimulation of the efferent loop with probiotics prior to closure of the protective ileostomy. A prospective, randomized, double-blind, controlled study was designed. All patients who underwent surgery for colorectal carcinoma with protective ileostomy between January 2017 and December 2018 were included. These patients were pending reconstructive surgery and were diagnosed with endoscopic and histological diversion colitis. Divided into two groups, a group stimulated with probiotics (SG) and a control group (CG). 34 cases and 35 controls were included in the study. Histological and endoscopic changes were evaluated after stimulation, after restorative surgery and during the short-term follow-up after surgery. A decrease in endoscopic pathological findings (mucosal friability, mucous erosions, polyps, edema, erythema and stenosis) and in histological findings (follicular hyperplasia, eosinophils, cryptic abscesses, lymphocyte infiltration, plasma cell infiltration and architecture distortion) was observed in SG. These results were statistically significant with a p < 0.001. The stimulation of the efferent loop of the ileostomy in patients with diversion colitis produced a decrease of the endoscopic and histological severity of colitis in the short term.
Highlights
Probiotics were defined as live microorganisms that improve the host’s health when administered in adequate amounts [1,2]
Between January 2017 and December 2018, 83 disease free patients with protective ileostomy after colorectal carcinoma resection were reviewed and included in the surgical waiting list for intestinal transit reconstruction. 78 of them met the endoscopic and histological criteria for diversion colitis diagnosis and 73 patients were randomized into two groups, intervention (n = 35) and control (n = 38). 69 patients completed the study, 1 of them from Stimulation group (SG) and 3 from control group (CG) abandoning the study due to anastomotic leak
We found a homogeneous distribution in the diversion colitis degree in pre-stimulation phase between SG and CG (p = 0.911), with 9 patients with severe diversion colitis in both groups (26.5% SG vs 25.7% CG), 23 patients with moderate diversion colitis in both groups (67.6% SG vs 65.7% CG) and 2 patients with mild diversion colitis in SG (5.9%) versus 3 patients in CG (8.6%)
Summary
Probiotics were defined as live microorganisms that improve the host’s health when administered in adequate amounts [1,2]. Depending on the strains included in probiotics, with different biochemical and immunological properties, the modulating effect of inflammation was evaluated in vitro and in vivo [11]. These biological effects are closely related to the microbiota metabolism and the ability to colonize the gastrointestinal tract [7]. Probiotics interact with the intestinal mucosa, reducing the molecular production of proinflammatory substances [1] Live bacteria, such as Lactobacillus, Bifidobacterium, and Enterococcus, present antimicrobial and immunomodulatory activity and improve the intestinal barrier [3]. This time-limited effect is essential to reduce the level of diversion colitis, since after reconstruction the effect of probiotics tends to disappear [15,16]
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