Diversion Colitis: Macro and Microscopic Findings after Probiotics Stimulation

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Microbiome Research

Background:

• Loop ileostomy for distal colonic anastomosis protection causes diversion colitis.
• This condition involves mucosal architectural changes due to inflammation and microflora alterations.
• Fecal stream diversion significantly impacts intestinal structure and function.

Purpose of the Study:

• To evaluate histological and endoscopic changes in diversion colitis.
• To assess the effect of probiotic stimulation of the efferent loop before ileostomy closure.
• To determine if probiotics can mitigate diversion colitis severity.

Main Methods:

• Prospective, randomized, double-blind, controlled study.
• Included patients with colorectal carcinoma and protective ileostomy diagnosed with diversion colitis.
• Compared a probiotic-stimulated group (SG) with a control group (CG) for endoscopic and histological changes.

Main Results:

• The probiotic-stimulated group (SG) showed a significant decrease in endoscopic findings (friability, erosions, polyps, edema, erythema, stenosis).
• Histological improvements were observed in SG, including reduced follicular hyperplasia, eosinophils, cryptic abscesses, and inflammation.
• Statistically significant improvements (p < 0.001) were noted in the SG for both endoscopic and histological parameters.

Conclusions:

• Stimulating the efferent loop of the ileostomy with probiotics can decrease the severity of diversion colitis.
• This intervention shows short-term benefits in reducing endoscopic and histological signs of colitis.
• Probiotics represent a promising approach to manage diversion colitis in patients with protective ileostomies.