Abstract
E. coli of the phylogenetic group B2 harbouring Extra intestinal Pathogenic Escherichia coli (ExPEC) genes are frequently seen as colonizers of the intestine in patients with active ulcerative colitis (UC). In this study, we describe the influence of E. coli Nissle (EcN) B2 as add-on treatment to conventional therapies in patients with active UC. For this study one hundred active UC patients were randomized to ciprofloxacin or placebo for 1 week followed by EcN or placebo for 7 weeks. Stool samples were collected at weeks 0, 1, 8, 12, where E. coli were characterized and fecal calprotectin was measured. We showed that in the active UC patient group receiving Placebo/EcN, fewer patients reached remission, in comparison to the patient group receiving Placebo/placebo (p < 0.05). Active UC patients initially colonized with E. coli B2 had increased fecal calprotectin values and Colitis Activity Index scores in comparison to patients colonized with E. coli A and D (p < 0.05*). In conclusion, treatment of UC patients with E. coli Nissle (B2) does not promote clinical remission and active UC patients colonized with E. coli B2 have an increased intestinal inflammation.
Highlights
Ulcerative colitis (UC) is a chronic inflammatory disease of the colon characterized by bloody diarrhoea and abdominal pain
We found no significant differences in the median values for fecal calprotectin between Placebo/placebo (D) and Placebo/E. coli strain Nissle 1917 (EcN) (C) and Cipro/EcN (A) at week 0
Since bacterial dysbiosis is suggested to cause disease relapses in ulcerative colitis (UC), antibiotics and probiotics have been used as treatment strategies[26,27,28]
Summary
Ulcerative colitis (UC) is a chronic inflammatory disease of the colon characterized by bloody diarrhoea and abdominal pain. Previous bacteriological analysis of colonic biopsies and fecal samples from patients with active UC showed an increased number of E. coli belonging to the B2 phylogenetic group harbouring extra-intestinal pathogenic Escherichia coli (ExPEC) genes[3,4,5]. E. coli B2 strains harbouring α-hemolysin caused increased intestinal permeability, and ExPEC isolated from UC patients had inflammation-inducing properties possibly linked to UC pathogenesis[6,7]. Fecal calprotectin predicts endoscopic disease activity far more reliably than the Colitis Activity Index (CAI) score[23]. Our aim was to evaluate the effects on intestinal inflammation of ciprofloxacin (Cipro) and orally administered EcN as add-on to conventional therapies in patients with active UC in correlation to fecal calprotectin values. The association between intestinal inflammation and primary colonization with E. coli B2 in active UC patients was assessed
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