title: Relationship between the severity of diversion colitis and the composition of colonic bacteria: a prospective study.
abstract: OBJECTIVE
  Diversion colitis is the inflammation of the excluded segment of the colon in patients undergoing ostomy. It has been suggested that a change in colonic flora may lead to colitis; however, direct evidence for this disease progression is lacking. The aim of this study was to evaluate the relationship between the severity of diversion colitis and the composition of colonic bacteria.
  
  
  METHODS
  We used culture methods and polymerase chain reaction to analyze the colonic microflora of patients who underwent rectal cancer resection with or without diversion ileostomy. In the diversion group, we also evaluated the severity of colonoscopic and pathologic colitis before reversal.
  
  
  RESULTS
  This study enrolled 48 patients: 26 in the diversion group and 22 in the control group. Significant differences were observed between the two groups in the levels of Staphylococcus (p=0.038), Enterococcus (p<0.001), Klebsiella (p<0.001), Pseudomonas (p=0.015), Lactobacillus (p=0.038), presence of anaerobes (p=0.019), and Bifidobacterium (p<0.001). A significant correlation between the severity of colitis and bacterial composition was only observed for Bifidobacterium (p=0.005, correlation coefficient=-0.531).
  
  
  CONCLUSIONS
  The colonic microflora differed significantly between the diversion and control groups. Bifidobacterium was negatively correlated with the severity of diversion colitis.
authors.affiliation: Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Se-Jin
authors.initials: SJ
authors.lastname: Baek
authors.affiliation: Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Seon-Hahn
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Chang-Kyu
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Roh
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.affiliation: Department of Pathology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Chul-Hwan
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003092:Colitis / Q000382:microbiology*; D003106:Colon / Q000382:microbiology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D019449:Pouchitis / Q000382:microbiology*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000382:microbiology / Q000601:surgery
keywords: Colonic bacteria; Diversion colitis; Polymerase chain reaction; Rectal neoplasms