| Scientist - News - 12-05-2008: LGG intake delays the first onset of pouchitis Beintema, Nienke Patients who have undergone colon resection with bowel reconstruction because of severe ulcerative colitis benefit from daily intake of LGG bacteria. Pouchitis, or inflammation of the surgically constructed intestinal pouch, cannot be cured by LGG bacteria but its first onset can be significantly delayed. Surgical removal of the colon may be necessary in patients with medically refractory ulcerative colitis – a chronic colon inflammation. In some cases, surgeons can use part of the small intestine to construct an artificial reservoir that replaces the colon. This reservoir, or pouch, remains susceptible to inflammation. "Pouch inflammation, or pouchitis, is the most frequently observed complication after this type of surgery," says dr. Martijn Gosselink, who recently defended his thesis Functional outcome after pouch surgery in patients with ulcerative colitis or rectal cancer at the Erasmus University of Rotterdam. "The condition strongly resembles ulcerative colitis. Since pouchitis proved to be treatable with antibiotics, we suspected that the composition of the microbial pouch flora played a role in causing this condition." To test this hypothesis, Gosselink and his colleagues compared the pouch flora of patients with and without pouchitis. It turned out that the flora of patients with pouchitis contained significantly higher numbers of harmful bacteria such as Clostridium perfringens and E. coli, and lower numbers of beneficial bacteria such as Lactobacillus and bifidobacteria. Gosselink: "In other words, pouchitis is characterised by an unbalance in the microbial pouch flora." LGG yoghurt Gosselink and his colleagues investigated whether oral intake of probiotics could have a positive effect on patients after pouch construction. They studied the effect of daily intake of Lactobacillus rhamnosus GG, or LGG: a probiotic that is contained in some popular yoghurt drinks. "Previous studies have shown the health benefits of LGG bacteria," says Gosselink. "Among other things, they help to restore the balance of the intestinal flora, and they activate our natural immune response." Gosselink’s research showed that daily intake of 350 ml of LGG-containing yoghurt – readily available in supermarkets – significantly delayed the first episode of pouchitis. After three years, only 7% of the LGG-consumers had experienced pouchitis, versus 29% in the control group. No adverse side effects were observed. "We cannot claim that the treatment prevents pouchitis," cautions Gosselink, “because some patients experienced pouchitis despite the treatment – although this may be due to differences in patient adherence. Therefore we rather speak of ‘delaying the first onset’ of pouchitis." In any case, as Gosselink points out, probiotics are to be preferred to antibiotics, which disturb the natural microbial balance rather than restoring it, and which may result in microbial resistance. Gosselink is currently training to be a surgeon, but maintains an active research interest. In close cooperation with his colleagues at the Erasmus Medical Centre he will continue this line of research. "One of the remaining questions is to what extent this result can be extrapolated from pouchitis to other types of intestinal inflammation," he says, "such as ulcerative colitis. We suspect that a similar effect may be observed, but we need to take a closer look at this before we can draw general conclusions." For more information: on PubMed «Back |