Abstract
PURPOSE: This study was undertaken to assess the electron microscopic and microbiologic findings in tissue biopsy samples from patients with pouchitis and to compare them with findings in patients with normal pouches, conventional ileostomies, and normal ileum. METHODS: Tissue samples were obtained from 78 patients: 23 patients with normal pouches endoscopically and histologically (Group 1), 12 patients with endoscopic and histologic evidence of inflammation (pouchitis) (Group 2), 14 patients who had either endoscopic or histologic evidence of inflammation but not both (Group 3), 20 patients with conventional ileostomies (Group 4), and 9 patients without ileostomies from whom biopsy samples of normal ileum were obtained (Group 5). RESULTS: The mean total aerobic facultative counts in the biopsy samples from the pouchitis patients were significantly higher when compared with biopsy samples from Groups 4 and 5 ( P <0.05). There were no significant differences in the mean anaerobic counts among the five groups. Positive cultures were obtained in 90 percent of patients with pouches compared with 69 percent of patients with conventional ileostomies or normal ileum ( P <0.05). Intramural bacteria were observed on electron microscopy in biopsy specimens of 47 percent patients with pouches compared with 14 percent of patients with conventional ileostomies or normal ileum ( P <0.05). However, the proportion of patients with positive cultures or intramural bacteria was not increased in the pouchitis group compared with the normal pouch group. CONCLUSION: These data suggest that intramural aerobic facultative bacterial counts are elevated in patients with pouchitis and may play a role in the pathogenesis of pouchitis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Madden MV, Farthing MJ, Nicholls RJ. Inflammation in ileal reservoirs: “pouchitis.” Gut 1990;31:247–9.
Luukonen P, Valtonen V, Sivonen A, Sipponen P, Jarvinen H. Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis. Dis Colon Rectum 1988;31:864–7.
Kelley DG, Phillips SF, Kelly KA, Weinstein WM, Gilchrist MJ. Dysfunction of the continent ileostomy: clinical features and bacteriology. Gut 1983;24:193–201.
O'Connell PR, Rankin DH, Weiland LH, Kelly KA. Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis. Br J Surg 1986;73:909–14.
Dvorak AM, Mihm MC Jr, Dvorak HF. Degranulation of basophilic leukocytes in allergic contact dermatitis reactions in man. J Immunol 1976;116:687–92.
Onderdonk AB, Moon NE, Kasper DL, Bartlett JG. Adherence ofBacteroides fragilis in vivo. Infect Immun 1978;19:1083–7.
Onderdonk AB, Dvorak A, McLeod RS,et al. Microbiologic assessment of tissue biopsy samples from patients with ileal pouch inflammation. J Clin Microbiol 1992;30:312–7.
Fleshman JW, Cohen Z, McLeod RS, Stern HS, Blair J. The ileal reservoir and ileo-anal anastomosis procedure: factors affecting technical and functional outcome. Dis Colon Rectum 1988;31:10–6.
Moskowitz RL. In: Symposium. Restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis 1986;1:16–7.
Philipson B, Brandberg A, Jagenburg R, Kock NG, Lager I, Ahren C. Mucosal morphology, bacteriology and absorption in intra-abdominal ileostomy reservoir. Scand J Gastroenterol 1975;10:145–53.
Shepherd NA, Jass JR, Duval I, Moskowitz RL, Nicholls RJ, Morson BC. Restorative proctocolectomy with ileal reservoir. Pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 1987;40:601–7.
Hulten L. Pouchitis—incidence and characteristics in the continent ileostomy. Int J Colorectal Dis 1989;4:208–10.
Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis 1986;1:167–74.
McLeod RS, Taylor DW, Cullen J, Cohen Z. Single patient randomized clinical trial. Use in determining optimum treatment for patient with inflammation of Kock continent ileostomy reservoir. Lancet 1986;1:726–8.
O'Connell PR. Evacuation and pouchitis. Int J Colorectal Dis 1989;4:224–5.
Nicholls RJ, Belliveau P, Neill M, Wilks M, Tabaqchali S. Restorative proctocolectomy with ileal reservoir: a patho-physiological assessment. Gut 1981;22:462–8.
Santavirta J, Mattila J, Kokki M, Matikainen M. Mucosal morphology and faecal bacteriology after ileoanal anastomosis. Int J Colorectal Dis 1991;6:38–41.
Author information
Authors and Affiliations
Additional information
This work was supported by a grant from the Crohn's and Colitis Foundation of America.
This work has been published previously as an abstract in Gastroenterology 1991;100:A230.
About this article
Cite this article
McLeod, R.S., Antonioli, D., Cullen, J. et al. Histologic and microbiologic features of biopsy samples from patients with normal and inflamed pouches. Dis Colon Rectum 37, 26–31 (1994). https://doi.org/10.1007/BF02047210
Issue Date:
DOI: https://doi.org/10.1007/BF02047210