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Diversion proctocolitis and response to treatment with short-chain fatty acids--a clinicopathological study in
Kamalesh Pal1, Sonal Tinalal2, Hussah Al Buainain3
1Division of Pediatric Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, University of Dammam, Al Khobar, KSA. kamalesh_pal@yahoo.com.
Insights
Diversion proctocolitis (DPC) is common in children after fecal diversion. Short-chain fatty acids (SCFA) effectively treat DPC symptoms and inflammation, with stoma closure offering a cure.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Inflammatory Bowel Disease Research
Background:
- Diversion proctocolitis (DPC) is an inflammatory condition of the colorectum following fecal stream diversion.
- Short-chain fatty acids (SCFA) are crucial for enterocyte health, but their efficacy in pediatric DPC is understudied.
Purpose of the Study:
- To determine the incidence, clinical, endoscopic, and histopathological features of DPC in children.
- To evaluate the effectiveness of SCFA treatment for DPC in pediatric patients.
Main Methods:
- Prospective study involving clinical, endoscopic, and histopathological evaluations of children with DPC.
- Data collected included patient demographics, stoma details, symptoms, endoscopic findings, and response to SCFA therapy.
Main Results:
- DPC occurred in 87% of children, with anorectal malformation as the primary indication for stoma.
- Sixty percent of patients developed symptoms within 2-9 months, primarily excessive mucous discharge.
- SCFA treatment led to clinical and endoscopic improvement in all patients, with 78% achieving histological resolution.
Conclusions:
- DPC is a frequent complication in pediatric patients with fecal diversion, particularly in males.
- SCFA therapy is effective in resolving DPC symptoms, endoscopic findings, and histopathological changes.
- Stoma closure provides a definitive cure for persistent DPC.
Objective:
Diversion proctocolitis (DPC) frequently develops in the colorectum after diversion of the fecal stream characterized by bleeding from the inflamed mucosa. Short-chain fatty acids (SCFA) are responsible for growth and differentiation of enterocytes. Adult series have reported variable response of DPC to luminal SCFA. There is dearth of studies in children. We aimed to study incidence, clinical, endoscopic, and histopathological characteristics of DPC and effect of SCFA in children.
Methods:
Prospectively clinical, endoscopic, and histopathological evaluation was done for DPC in children undergoing fecal diversion. Patient characteristics, type and duration of stoma, symptoms, endoscopy and biopsy findings, duration of treatment and response to SCFA, time of closure of stoma, and any associated gut anomaly were recorded.
Results:
Fifteen children completed the study. Anorectal malformation was the commonest indication for stoma. Sixty percent were symptomatic within 2-9 months, excessive mucous discharge being the commonest symptom. All had at least one positive endoscopic finding; erythema, edema, and exudates being the commonest findings. All DPCs improved clinically and endoscopically following SCFA. Histological resolution was seen in 78 %, while 22 % had persistent disease. Closure of stoma showed complete resolution of DPC.
Conclusion:
DPC was common (87 %) following stoma formation in children with strong male preponderance (6.5:1). The commonest indication for stoma was anorectal malformation (67 %). Clinical, endoscopic, and histopathological changes appeared within 2-9 months with symptomatic DPC in 60 %. All patients (100 %) had at least one positive endoscopic finding, histopathological examination confirmed the diagnosis. SCFA led to symptomatic, endoscopic, and histopathological resolution of DPCs. Closure of stoma cured all the persistent DPCs.
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