Abstract
The objective was to determine the bacterial composition in inflamed and non-inflamed pouches for comparison to the microbiota of healthy individuals. Pouch patients and healthy individuals were included between November 2017 and June 2019 at the Department of Gastrointestinal Surgery, Aalborg University Hospital, Denmark. A faecal sample was collected from all participants for microbiota analysis using 16S rRNA amplicon sequencing. Overall, 38 participants were included in the study. Eleven patients with a normally functioning pouch, 9 patients with chronic pouchitis, 6 patients with familial adenomatous polyposis, and 12 healthy individuals. Patients with chronic pouchitis had overall lower microbial diversity and richness compared to patients with a normal pouch function (p < 0.001 and p = 0.009) and healthy individuals (p < 0.001 and p < 0.001). No significant difference was found between patients with familial adenomatous polyposis and chronic pouchitis (microbial diversity p = 0.39 and richness p = 0.78). Several taxa from the family Enterobacteriaceae, especially genus Escherichia, were associated primarily with patients with chronic pouchitis, while taxa from the genus Bacteroides primarily were associated with healthy individuals and patients with a normally functioning pouch. Finally, a microbial composition gradient could be established from healthy individuals through patients with normal pouch function and familial adenomatous polyposis to patients with chronic pouchitis.
Highlights
Chronic pouchitis is the primary reason for long-term functional disturbance for patients with an ileal pouch–anal anastomosis (IPAA) [1,2]
A microbial composition gradient could be established from healthy individuals through patients with normal pouch function and familial adenomatous polyposis to patients with chronic pouchitis
Pouchitis is unusual in familial adenomatous polyposis (FAP) patients with pouches, but occurs in up to 60% of patients with a pouch created in the surgical treatment of ulcerative colitis (UC) [3,4]
Summary
Chronic pouchitis is the primary reason for long-term functional disturbance for patients with an ileal pouch–anal anastomosis (IPAA) [1,2]. Current evidence suggests that the gut microbiota is a major factor in the aetiology of pouchitis [5]. This hypothesis is supported by clinical observations of the symptomatic effect of antibiotic treatment. It is likely that there is an abnormal activation of the immune system in pouchitis, caused by yet unidentified factors. The initial success of antibiotics in the treatment of pouchitis indicates that gut bacteria is a likely trigger, activating the mucosal immune system [7]. Use of molecular techniques for DNA-based identification of the composition of the microbiota has provided researchers with the opportunity to evaluate the microbiota profile in the pouch more effectively [13]. The aim of our study was to determine the bacterial composition of inflamed and non-inflamed pouch microbiota and compare it to the microbiota of healthy individuals, using bacterial microbiota profiling
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