title: Increased bacterial permeation in long-lasting ileoanal pouches.
abstract: OBJECTIVE
  Bacterial overgrowth appears to play an important role in the pathogenesis of ileoanal pouches. Therefore, the capability of bacterial permeation and its determinants is of great interest. The aim of this study was to examine bacterial permeation in the ileoanal pouch and to correlate the results with the degree of inflammation, the epithelial resistance, the mucosal transport function, and the age of the ileoanal pouches.
  
  
  METHODS
  Biopsies were taken from 54 patients before colectomy (n = 13; preileal pouch-anal anastomosis [IPAA]), and closure of ileostomy (n = 7; deviation), <1 year after closure of ileostomy (n = 8; intact pouch I), >1 year after closure of ileostomy (n = 16; intact pouch II), in the case of pouchitis (n = 11), and in 11 controls. Tissues were mounted in a miniaturized Ussing chamber. Escherichia coli was added to the mucosal side of the Ussing chamber, and the permeation was proven by serosal presence of E. coli. Epithelial and subepithelial resistance was determined by transmural impedance analysis. Active Na-glucose cotransport and active Cl secretion were measured. Specimens were analyzed by fluorescent in situ hybridization with oligonucleotide probes targeting the bacterial 16s ribosomal RNA. The bacteria in and on the tissue were enumerated.
  
  
  RESULTS
  Bacterial permeation occurred in 2 of 13 pre-IPAA, 2 of 7 deviations, 0 of 8 intact pouch I, 9 of 16 intact pouch II, 5 of 11 pouchitis specimens, and 0 of 11 ileum controls. The frequency of bacterial permeation in the intact pouch II group is higher than in the intact pouch I group (P < 0.001). Epithelial resistance, mannitol fluxes, electrogenic chloride secretion, sodium-glucose cotransport of the bacterially permeated specimens versus nonpermeated of the intact pouch II group, and the pouchitis group and subepithelial resistance remained unchanged. Intramural bacteria could be detected by fluorescence in situ hybridization mainly in long-lasting pouches, but there was no correlation with bacterial permeation.
  
  
  CONCLUSIONS
  The long-lasting ileoanal pouch is associated with increased bacterial permeability. This is not correlated with a disturbed function of the pouch mucosa but could be a precursor of pouchitis.
authors.affiliation: Department of Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. anton.kroesen@charite.de
authors.forename: Anton J
authors.initials: AJ
authors.lastname: Kroesen
authors.forename: Patrick
authors.initials: P
authors.lastname: Leistenschneider
authors.forename: Katrin
authors.initials: K
authors.lastname: Lehmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Ransco
authors.forename: Sonja
authors.initials: S
authors.lastname: Dullat
authors.forename: Michael
authors.initials: M
authors.lastname: Blaut
authors.forename: Joerg D
authors.initials: JD
authors.lastname: Schulzke
authors.forename: Michael
authors.initials: M
authors.lastname: Fromm
authors.forename: Heinz J
authors.initials: HJ
authors.lastname: Buhr
mesh_terms: D019325:3-O-Methylglucose / Q000493:pharmacokinetics; D000328:Adult; D018988:Bacterial Translocation; D001692:Biological Transport; D002712:Chlorides / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000382:microbiology* / Q000502:physiology; D017097:Electric Impedance; D004926:Escherichia coli / Q000502:physiology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism / Q000382:microbiology; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics; D019449:Pouchitis / Q000378:metabolism / Q000382:microbiology*; D012964:Sodium / Q000378:metabolism; D013234:Stem Cells / Q000166:cytology
chemical_list: D002712:Chlorides; D019325:3-O-Methylglucose; D008353:Mannitol; D012964:Sodium