title: Relationship between pouch microbiota and pouchitis following restorative proctocolectomy for ulcerative colitis.
abstract: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for many patients with medically refractory ulcerative colitis (UC) and familial adenomatous polyposis (FAP). UC patients with IPAA (UC-IPAA) are, nevertheless, susceptible to inflammatory and noninflammatory sequelae such as pouchitis, which is only rarely noted in FAP patients with IPAA. Pouchitis is the most frequent long-term complication of UC-IPAA patients, with a cumulative prevalence of up to 50%. Although the aetiology of pouchitis remains unclear, accumulating evidence suggests that a dysbiosis of the pouch microbiota and an abnormal mucosal immune response are implicated in its pathogenesis. Studies using culture and molecular techniques have detected a dysbiosis of the pouch microbiota in patients with pouchitis. Risk factors, genetic associations, and serological markers suggest that interactions between the host immune response and the pouch microbiota underlie the aetiology of this idiopathic inflammatory condition. This systematic review focuses on the dysbiosis of the microbiota that inhabit the pouch in UC and FAP patients and its interaction with the mucosal immune system. A meta-analysis was not attempted due to the highly heterogeneous microbiota composition and the different detection methods used by the various studies. Although no specific bacterial species, genus, or family has as yet been identified as pathogenic, there is evidence that a dysbiosis characterized by decreased gut microbiota diversity in UC-IPAA patients may, in genetically predisposed subjects, lead to aberrant mucosal immune regulation triggering an inflammatory process.
authors.affiliation: Imerio Angriman, Department of Surgery, Gastroenterology and Oncology, University of Padova, 35128 Padova, Italy.
authors.forename: Imerio
authors.initials: I
authors.lastname: Angriman
authors.affiliation: Imerio Angriman, Department of Surgery, Gastroenterology and Oncology, University of Padova, 35128 Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.affiliation: Imerio Angriman, Department of Surgery, Gastroenterology and Oncology, University of Padova, 35128 Padova, Italy.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Castagliuolo
mesh_terms: D001419:Bacteria / Q000276:immunology / Q000472:pathogenicity*; D003093:Colitis, Ulcerative / Q000276:immunology / Q000382:microbiology / Q000601:surgery*; D064806:Dysbiosis; D054884:Host-Pathogen Interactions; D006801:Humans; D018928:Immunity, Mucosal; D018836:Inflammation Mediators / Q000378:metabolism; D019449:Pouchitis / Q000276:immunology / Q000378:metabolism / Q000382:microbiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D018836:Inflammation Mediators
keywords: Bacteria; Crohn’s disease; Ileal-pouch-anal anastomosis; Inflammation of the ileal pouch; Inflammatory bowel disease; Microbiome; Microbiota; Pouchitis; Ulcerative colitis
references.citation: Dis Colon Rectum. 1995 May;38(5):488-93
references.pmid: 7736879
references.citation: Gut. 2004 Jul;53(7):1057
references.pmid: 15194668
references.citation: Proc Natl Acad Sci U S A. 1990 Jan;87(1):210-4
references.pmid: 1688654
references.citation: Int J Colorectal Dis. 1998;13(2):103-7
references.pmid: 9638497
references.citation: Ann Surg. 1995 Aug;222(2):120-7
references.pmid: 7639579
references.citation: Am J Gastroenterol. 2000 Jan;95(1 Suppl):S19-21
references.pmid: 10634224
references.citation: J Biol Chem. 1996 Feb 9;271(6):2935-40
references.pmid: 8621683
references.citation: Ann Surg. 1998 May;227(5):654-62; discussion 663-5
references.pmid: 9605657
references.citation: Gut. 2005 Aug;54(8):1182-93
references.pmid: 15840688
references.citation: Int J Colorectal Dis. 1989 Dec;4(4):205-29
references.pmid: 2693561
references.citation: Gastroenterology. 2005 Jun;128(7):2020-8
references.pmid: 15940634
references.citation: Eur J Gastroenterol Hepatol. 2001 Jul;13(7):771-6
references.pmid: 11474305
references.citation: Am J Respir Cell Mol Biol. 2000 Jun;22(6):714-21
references.pmid: 10837369
references.citation: J Biol Chem. 1992 Nov 15;267(32):23216-25
references.pmid: 1429669
references.citation: Scand J Gastroenterol. 2007 Aug;42(8):973-85
references.pmid: 17613928
references.citation: Arch Surg. 1996 May;131(5):497-500; discussion 501-2
references.pmid: 8624195
references.citation: J Clin Microbiol. 1992 Feb;30(2):312-7
references.pmid: 1537898
references.citation: Clin Gastroenterol Hepatol. 2009 May;7(5):545-8
references.pmid: 19418603
references.citation: Gut. 2004 Dec;53(12):1801-5
references.pmid: 15542518
references.citation: Dis Colon Rectum. 2005 Mar;48(3):469-75
references.pmid: 15747080
references.citation: Hum Mol Genet. 1999 Feb;8(2):307-11
references.pmid: 9931338
references.citation: Dis Colon Rectum. 2006 Sep;49(9):1293-306
references.pmid: 16830218
references.citation: J Gastrointest Surg. 2012 Jan;16(1):188-201; discussion 201-2
references.pmid: 21983950
references.citation: Gut. 2001 Feb;48(2):176-85
references.pmid: 11156637
references.citation: Surgery. 2011 Jul;150(1):56-67
references.pmid: 21549404
references.citation: Inflamm Bowel Dis. 2012 May;18(5):925-34
references.pmid: 22114001
references.citation: Scand J Gastroenterol. 1993 Aug;28(8):695-700
references.pmid: 8210985
references.citation: J Clin Invest. 1989 Aug;84(2):553-61
references.pmid: 2668334
references.citation: Gastroenterology. 2004 May;126(5):1280-6
references.pmid: 15131788
references.citation: Dis Colon Rectum. 2002 Mar;45(3):384-8
references.pmid: 12068199
references.citation: Drugs. 2003;63(5):453-61
references.pmid: 12600225
references.citation: Gut. 2008 Nov;57(11):1605-15
references.pmid: 18941009
references.citation: Gut. 2000 Sep;47(3):397-403
references.pmid: 10940278
references.citation: Inflamm Bowel Dis. 2012 Jun;18(6):1146-55
references.pmid: 22021180
references.citation: Immunology. 1997 Oct;92(2):234-43
references.pmid: 9415032
references.citation: Ann Surg. 1990 May;211(5):622-7; discussion 627-9
references.pmid: 2339922
references.citation: Gut. 1996 Feb;38(2):234-9
references.pmid: 8801203
references.citation: Curr Opin Immunol. 1994 Aug;6(4):584-9
references.pmid: 7946046
references.citation: World J Gastroenterol. 2006 Feb 21;12(7):1056-62
references.pmid: 16534846
references.citation: Int J Colorectal Dis. 1986 Jul;1(3):167-74
references.pmid: 3039030
references.citation: Dig Dis Sci. 2007 Dec;52(12):3321-8
references.pmid: 17410449
references.citation: Inflamm Bowel Dis. 2011 May;17(5):1092-100
references.pmid: 20845425
references.citation: Gastroenterology. 2003 May;124(6):1636-50
references.pmid: 12761722
references.citation: Gastroenterology. 2004 Dec;127(6):1809-14
references.pmid: 15578518
references.citation: Aliment Pharmacol Ther. 2002 May;16(5):909-17
references.pmid: 11966499
references.citation: Dis Colon Rectum. 1994 Jan;37(1):26-31
references.pmid: 8287743
references.citation: Microbiol Immunol. 2002;46(8):535-48
references.pmid: 12363017
references.citation: Surgery. 2009 Apr;145(4):435-47
references.pmid: 19303993
references.citation: Br J Surg. 2006 Nov;93(11):1325-34
references.pmid: 17058325
references.citation: J Clin Microbiol. 2006 Nov;44(11):4136-41
references.pmid: 16988016
references.citation: Surg Today. 2006;36(3):287-90
references.pmid: 16493544
references.citation: Eur J Gastroenterol Hepatol. 2002 Jul;14(7):757-65
references.pmid: 12169985
references.citation: Gastroenterology. 1989 Mar;96(3):817-24
references.pmid: 2914643
references.citation: Inflamm Bowel Dis. 2001 Nov;7(4):301-5
references.pmid: 11720319
references.citation: PLoS One. 2013 Sep 24;8(9):e66934
references.pmid: 24086242
references.citation: Biochem Biophys Res Commun. 1996 Jul 16;224(2):397-405
references.pmid: 8702401
references.citation: Gut. 1993 Jan;34(1):101-5
references.pmid: 8381756
references.citation: Clin Gastroenterol Hepatol. 2005 Jan;3(1):60-6
references.pmid: 15645406
references.citation: Inflamm Bowel Dis. 2007 Aug;13(8):955-62
references.pmid: 17455205
references.citation: Appl Environ Microbiol. 2002 Jul;68(7):3401-7
references.pmid: 12089021
references.citation: Gastroenterology. 2008 Feb;134(2):577-94
references.pmid: 18242222
references.citation: Dig Dis Sci. 2002 Jun;47(6):1349-55
references.pmid: 12064812
references.citation: J Biol Chem. 2002 Oct 11;277(41):38168-78
references.pmid: 12140289
references.citation: World J Gastroenterol. 2005 Feb 28;11(8):1131-40
references.pmid: 15754393
references.citation: Proc Natl Acad Sci U S A. 2007 Aug 21;104(34):13780-5
references.pmid: 17699621
references.citation: Clin Gastroenterol Hepatol. 2007 Mar;5(3):352-60
references.pmid: 17368235
references.citation: Digestion. 1995;56(1):52-6
references.pmid: 7895933
references.citation: Gastroenterology. 2003 May;124(5):1202-9
references.pmid: 12730861
references.citation: J Surg Res. 2011 Aug;169(2):e145-54
references.pmid: 21601883
references.citation: Dis Colon Rectum. 2004 Sep;47(9):1519-25
references.pmid: 15486751
references.citation: Gut. 2006 Dec;55(12):1760-7
references.pmid: 16648155
references.citation: Clin Gastroenterol Hepatol. 2008 Jul;6(7):782-8
references.pmid: 18467184
references.citation: Ann Surg. 2003 Dec;238(6 Suppl):S42-8
references.pmid: 14703744
references.citation: World J Surg. 1998 Apr;22(4):347-51
references.pmid: 9523515
references.citation: Gut. 2001 Nov;49(5):671-7
references.pmid: 11600470
references.citation: Clin Gastroenterol Hepatol. 2008 May;6(5):561-8
references.pmid: 18378498
references.citation: Ann Surg. 2010 Jul;252(1):90-8
references.pmid: 20562611
references.citation: Physiol Rev. 2010 Jul;90(3):859-904
references.pmid: 20664075
references.citation: J Clin Pathol. 1987 Jun;40(6):601-7
references.pmid: 3611389
references.citation: Inflamm Bowel Dis. 2010 Apr;16(4):684-95
references.pmid: 19774643
references.citation: Mayo Clin Proc. 1994 May;69(5):409-15
references.pmid: 8170189
references.citation: Gastroenterology. 2000 Aug;119(2):305-9
references.pmid: 10930365
references.citation: J Clin Microbiol. 2006 Sep;44(9):3172-7
references.pmid: 16954244
references.citation: Gut. 2004 Jan;53(1):108-14
references.pmid: 14684584
references.citation: J Immunol. 1999 Dec 15;163(12):6718-24
references.pmid: 10586069
references.citation: Science. 2005 Jun 10;308(5728):1635-8
references.pmid: 15831718
references.citation: Hum Mol Genet. 2001 Mar 1;10(5):445-56
references.pmid: 11181568
references.citation: Dis Colon Rectum. 2003 Feb;46(2):267-70
references.pmid: 12576902
references.citation: Gut. 2006 Jun;55(6):833-41
references.pmid: 16401690
references.citation: Gut. 2004 May;53(5):685-93
references.pmid: 15082587