Influence of Fermented Milk on Clinical State, Fecal Bacterial Counts and Biochemical Characteristics in Patients with Ileal- Pouch- Anal-Anastomosis

Abstract

Pouchitis is a condition with acute or chronic inflammation in the ileal pouch of colectomized patients. A disturbed microecology in the pouch has been suggested as a possible cause. The present study was an attempt to investigate if a fermented milk product containing live lactobacilli and bifidobacteria might influence on the intestinal microecology of IPAA-patients. Five hundred ml of a fermented milk product containing live lactobacilli (La-5) and bifidobacteriae (Bb-12) (Cultura, TM), was given in its regular form or heat-treated, in a randomized, double blinded fashion, to 16 patients operated on with ileal- pouch- anal-anastomosis (IPAA) for ulcerative colitis (UC). Symptoms recordings, stool cultures and determination of 6 different microflora associated characteristics (MACs);(short-chain fatty acids (SCFAs), urobilinogen, mucin degradation, coprostanol, fecal tryptic activity (FTA), and beta-aspartyl glycin) were performed at inclusion, after 1 and 2 weeks. In the group given regular Cultura, daily stool frequency was reduced from median 5.8 to 2.8. It was unchanged in the group given heat-treated Cultura. With regular Cultura the number of lactobacilli increased significantly during intervention, and remained elevated one week thereafter. The number of bifidobacteriae increased significantly during intervention, but was back to baseline one week thereafter. With heat-treated Cultura, no significant change was observed. Significant reduction in stool frequency was observed among the patients given regular Cultura. No change was observed among those given heat-treated Cultura. No major effects on six MACs were observed. Keywords: lactobacilli, bifidobacteria, ileal pouch, fecal tryptic activity, microflora-associated characteristic (MAC), probiotics.