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Original article
Specific members of the predominant gut microbiota predict pouchitis following colectomy and IPAA in UC
  1. Kathleen Machiels1,
  2. João Sabino1,
  3. Leen Vandermosten1,
  4. Marie Joossens2,3,4,
  5. Ingrid Arijs1,
  6. Magali de Bruyn1,
  7. Venessa Eeckhaut5,
  8. Gert Van Assche1,
  9. Marc Ferrante1,
  10. Jan Verhaegen6,
  11. Kristel Van Steen7,
  12. Filip Van Immerseel5,
  13. Geert Huys8,
  14. Kristin Verbeke1,
  15. Albert Wolthuis1,
  16. Anthony de Buck Van Overstraeten1,
  17. Andre D'Hoore1,
  18. Paul Rutgeerts1,
  19. Séverine Vermeire1
  1. 1Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospital Leuven, KU Leuven, Leuven, Belgium
  2. 2Department Microbiology and Immunology, KU Leuven, Leuven, Belgium
  3. 3Center for the Biology of Disease, VIB, Leuven, Belgium
  4. 4Faculty of Sciences and Bioengineering Sciences, Microbiology Unit, Vrije Universiteit Brussel, Brussels, Belgium
  5. 5Department of Pathology, Bacteriology and Avian Diseases, Ghent University, Merelbeke, Belgium
  6. 6Department of Microbiology and Immunology, University Hospital Leuven, KU Leuven, Leuven, Belgium
  7. 7Department of Electrical Engineering and Computer Science, Montefiore Institute, Liège, Belgium
  8. 8Laboratory of Microbiology & BCCM/LMG Bacteria Collection, Faculty of Sciences, Ghent University, Ghent, Belgium
  1. Correspondence to Dr Severine Vermeire, Gastroenterology Department, University Hospital Leuven, Herestraat 49, Leuven 3000, Belgium; Severine.Vermeire{at}uzleuven.be

Abstract

Objective Pouchitis is the most common complication after colectomy with ileal pouch-anal anastomosis (IPAA) for UC and the risk is the highest within the 1st year after surgery. The pathogenesis is not completely understood but clinical response to antibiotics suggests a role for gut microbiota. We hypothesised that the risk for pouchitis can be predicted based on the faecal microbial composition before colectomy.

Design Faecal samples from 21 patients with UC undergoing IPAA were prospectively collected before colectomy and at predefined clinical visits at 1 month, 3 months, 6 months and 12 months after IPAA. The predominant microbiota was analysed using community profiling with denaturing gradient gel electrophoresis followed by quantitative real-time PCR validation.

Results Cluster analysis before colectomy distinguished patients with pouchitis from those with normal pouch during the 1st year of follow-up. In patients developing pouchitis, an increase of Ruminococcus gnavus (p<0.001), Bacteroides vulgatus (p=0.043), Clostridium perfringens (p=0.011) and a reduction of two Lachnospiraceae genera (Blautia (p=0.04), Roseburia (p=0.008)) was observed. A score combining these five bacterial risk factors was calculated and presence of at least two risk factors showed a sensitivity and specificity of 100% and 63.6%, respectively.

Conclusions Presence of R. gnavus, B. vulgatus and C. perfringens and absence of Blautia and Roseburia in faecal samples of patients with UC before surgery is associated with a higher risk of pouchitis after IPAA. Our findings suggest new predictive and therapeutic strategies in patients undergoing colectomy with IPAA.

  • IBD BASIC RESEARCH
  • ILEOANAL POUCH
  • INFLAMMATORY BOWEL DISEASE
  • INTESTINAL BACTERIA
  • POUCHITIS

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Footnotes

  • Twitter Follow Marie Joossens at @JoossensM

  • Contributors KM: study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, statistical analysis and technical support; JS: technical support; LV: technical support; MJ: drafting of the manuscript; IA: drafting of the manuscript; MdB: statistical analysis; VE: technical support; GVA: critical revision of the manuscript for important intellectual content; MF: critical revision of the manuscript for important intellectual content; JV: critical revision of the manuscript for important intellectual content; KVS: statistical analysis, critical revision of the manuscript for important intellectual content; FVI: material support, critical revision of the manuscript for important intellectual content; GH: material support, critical revision of the manuscript for important intellectual content; KV: material support, critical revision of the manuscript for important intellectual content; AW: critical revision of the manuscript for important intellectual content; AdBVO: critical revision of the manuscript for important intellectual content; AD: critical revision of the manuscript for important intellectual content; PR: critical revision of the manuscript for important intellectual content; SV: study concept and design, acquisition of data, interpretation of data, drafting of the manuscript, obtained funding, material support and study supervision.

  • Funding This work was supported by the Geconcerteerde Onderzoekacties (GOA) of the KU Leuven (grant number GOA/11/015); KM, MJ and IA are postdoctoral fellows and SV, MF and GVA are senior clinical investigators of the Fund for Scientific Research-Flanders, Belgium (FWO-Vlaanderen); MdB is a PhD student funded by a fellowship from the Agency for Innovation by Science and Technology (IWT).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Ethics Committee of University of Leuven (Ethics committee approval, S52544 and S53684).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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