Pouchitis is a common complication following proctocolectomy with ileal pouch anal anastomosis (IPAA) in patients with ulcerative colitis (UC). It affects the quality of life and can become a chronic problem. The aetiology of pouchitis is not completely understood. A crucial role of the intestinal microbiota has been suggested, but no causative agent has been identified so far. Furthermore, the defensin expression and the epithelial integrity are altered in inflammatory bowel diseases and may play an important role in the development of intestinal inflammation. Therefore, it has been hypothesized that the interaction between an altered microbiota composition, a defective epithelial integrity and changes in innate defense parameters such as defensins has a pivotal role in the development of pouchitis in UC patients.
Primary Outcome Measures:
- Differences in the intestinal microbiota composition between pouch patients with and without pouchitis [ Time Frame: 24 months. ] [ Designated as safety issue: No ]
A phylogenetic microarray will be used to characterize the luminal and mucosal microbiota composition (based on the SSU rRNA gene)of pouch patients with and without pouchitis. Anticipated results are the identification of specific bacterial profiles, genera and/or species dat are discriminating between subgroups.
Biospecimen Retention: Samples With DNA
Secondary Outcome Measures:
- The expression of defensins in the intestinal mucosa [ Time Frame: 24 months ] [ Designated as safety issue: No ]
The mRNA expression levels of human alfa and beta-defensins in intestinal mucosal biopsies will be assessed by real time PCR
- The intestinal permeability [ Time Frame: 24 months. ] [ Designated as safety issue: No ]
The epithelial integrity will be studied by the multiple sugar test to assess small intestinal and whole gut permeability.
- Inflammatory mediators [ Time Frame: 24 months ] [ Designated as safety issue: No ]
Cytokine levels will be studied in serum and in intestinal biopsies. Furthermore, a histological evaluation and the MPO activity will be studied in these biopsies and calprotectin levels will be determined in 'fecal' sampels.
- The expression of tight-junction associated proteins [ Time Frame: 24 months. ] [ Designated as safety issue: No ]
The intestinal tight junctions-associated proteins will be studied by immune staining of intestinal biopsies and mRNA levels in intestinal biopsies using real time PCR. Biopsies will be collected from standardised locations.
In the prospective study the following biospecimens will be collected: faeces, serum, plasma, leucocytes, urine, intestinal biopsies and mucus
| Estimated Enrollment:
| Study Start Date:
| Estimated Study Completion Date:
| Estimated Primary Completion Date:
||November 2014 (Final data collection date for primary outcome measure)
ulcerative colitis patients with a pouch
- ulcerative colitis patients undergoing proctocolectomy with an ileal pouch anal anastomosis
- comparing patients with versus those without pouchitis
- no intervention