Specific members of the predominant gut microbiota predict pouchitis following colectomy and IPAA in UC
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Published on: May 31, 2024
Kathleen Machiels1, João Sabino1, Leen Vandermosten1
1Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospital Leuven, KU Leuven, Leuven, Belgium.
Insights
Pre-surgery gut bacteria composition can predict pouchitis risk in ulcerative colitis patients. Specific bacterial changes before colectomy indicate a higher likelihood of developing pouchitis after ileal pouch-anal anastomosis (IPAA).
Area of Science:
- Gastroenterology
- Microbiology
- Surgical Complications
Background:
- Pouchitis is the most frequent complication following colectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).
- The exact pathogenesis of pouchitis remains unclear, but antibiotic responsiveness suggests a role for gut microbiota.
- Predicting pouchitis risk before surgery could enable proactive management.
Purpose of the Study:
- To investigate if fecal microbial composition before colectomy can predict the risk of developing pouchitis after IPAA.
- To identify specific bacterial markers associated with pouchitis development.
Main Methods:
- Prospective collection of fecal samples from 21 UC patients undergoing IPAA before colectomy and at 1, 3, 6, and 12 months post-surgery.
- Analysis of predominant microbiota using denaturing gradient gel electrophoresis (DGGE) and quantitative real-time PCR (qPCR).
Main Results:
- Cluster analysis of pre-colectomy fecal samples distinguished patients who developed pouchitis from those who did not.
- Patients developing pouchitis showed increased Ruminococcus gnavus, Bacteroides vulgatus, and Clostridium perfringens, and decreased Blautia and Roseburia.
- A predictive score based on these five bacteria demonstrated 100% sensitivity and 63.6% specificity for pouchitis risk.
Conclusions:
- Specific pre-operative fecal microbial profiles, including the presence of R. gnavus, B. vulgatus, C. perfringens and absence of Blautia and Roseburia, are associated with an increased risk of pouchitis.
- These findings suggest potential for novel predictive and therapeutic strategies for pouchitis in patients undergoing IPAA.
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.
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