Diversion Proctocolitis and Response to Treatment with Short-chain Fatty Acids--a Clinicopathological Study in Children

Overview

Journal Indian J Gastroenterol

Specialty Gastroenterology

Date 2015 Aug 6

PMID 26243588

Citations 7

Authors

Kamalesh Pal

Sonal Tinalal

Hussah Al Buainain

Vinod Prem Singh

Affiliations

Soon will be listed here.

Abstract

Objective: Diversion proctocolitis (DPC) frequently develops in the colorectum after diversion of the fecal stream characterized by bleeding from the inflamed mucosa. Short-chain fatty acids (SCFA) are responsible for growth and differentiation of enterocytes. Adult series have reported variable response of DPC to luminal SCFA. There is dearth of studies in children. We aimed to study incidence, clinical, endoscopic, and histopathological characteristics of DPC and effect of SCFA in children.

Methods: Prospectively clinical, endoscopic, and histopathological evaluation was done for DPC in children undergoing fecal diversion. Patient characteristics, type and duration of stoma, symptoms, endoscopy and biopsy findings, duration of treatment and response to SCFA, time of closure of stoma, and any associated gut anomaly were recorded.

Results: Fifteen children completed the study. Anorectal malformation was the commonest indication for stoma. Sixty percent were symptomatic within 2-9 months, excessive mucous discharge being the commonest symptom. All had at least one positive endoscopic finding; erythema, edema, and exudates being the commonest findings. All DPCs improved clinically and endoscopically following SCFA. Histological resolution was seen in 78 %, while 22 % had persistent disease. Closure of stoma showed complete resolution of DPC.

Conclusion: DPC was common (87 %) following stoma formation in children with strong male preponderance (6.5:1). The commonest indication for stoma was anorectal malformation (67 %). Clinical, endoscopic, and histopathological changes appeared within 2-9 months with symptomatic DPC in 60 %. All patients (100 %) had at least one positive endoscopic finding, histopathological examination confirmed the diagnosis. SCFA led to symptomatic, endoscopic, and histopathological resolution of DPCs. Closure of stoma cured all the persistent DPCs.

Citing Articles

An updated review on the treatment for diversion colitis and pouchitis, with a focus on the utility of autologous fecal microbiota transplantation and its relationship with the intestinal microbiota.

Tominaga K, Kojima Y, Kawata Y, Takahashi K, Sato H, Tsuchiya A Biosci Microbiota Food Health. 2024; 43(3):162-169.

PMID: 38966047 PMC: 11220330. DOI: 10.12938/bmfh.2024-014.

Interaction between the intestinal flora and the severity of diversion colitis after low anterior resection of rectal cancer.

Sun Q, Shi Y, Liang X, Lu H, Huang Y, Zhu L Front Oncol. 2023; 13:1001819.

PMID: 36998438 PMC: 10043175. DOI: 10.3389/fonc.2023.1001819.

Gut microbial metabolome in inflammatory bowel disease: From association to therapeutic perspectives.

Li M, Yang L, Mu C, Sun Y, Gu Y, Chen D Comput Struct Biotechnol J. 2022; 20:2402-2414.

PMID: 35664229 PMC: 9125655. DOI: 10.1016/j.csbj.2022.03.038.

Subtotal colectomy in ulcerative colitis-long term considerations for the rectal stump.

Hennessy O, Egan L, Joyce M World J Gastrointest Surg. 2021; 13(2):198-209.

PMID: 33643539 PMC: 7898189. DOI: 10.4240/wjgs.v13.i2.198.

Evaluation of intestinal microbiota, short-chain fatty acids, and immunoglobulin a in diversion colitis.

Tominaga K, Tsuchiya A, Mizusawa T, Matsumoto A, Minemura A, Oka K Biochem Biophys Rep. 2021; 25:100892.

PMID: 33458259 PMC: 7797511. DOI: 10.1016/j.bbrep.2020.100892.

References

Ordein J, Di Lorenzo C, Flores A, Hyman P . Diversion colitis in children with severe gastrointestinal motility disorders. Am J Gastroenterol. 1992; 87(1):88-90. View

Cummings J, Pomare E, Branch W, Naylor C, Macfarlane G . Short chain fatty acids in human large intestine, portal, hepatic and venous blood. Gut. 1987; 28(10):1221-7. PMC: 1433442. DOI: 10.1136/gut.28.10.1221. View

Glotzer D, Glick M, Goldman H . Proctitis and colitis following diversion of the fecal stream. Gastroenterology. 1981; 80(3):438-41. View

Ruppin H, Bar-Meir S, SOERGEL K, Wood C, Schmitt Jr M . Absorption of short-chain fatty acids by the colon. Gastroenterology. 1980; 78(6):1500-7. View

Guillemot F, Colombel J, Neut C, Verplanck N, Lecomte M, Romond C . Treatment of diversion colitis by short-chain fatty acids. Prospective and double-blind study. Dis Colon Rectum. 1991; 34(10):861-4. DOI: 10.1007/BF02049697. View

Harig J, SOERGEL K, Komorowski R, Wood C . Treatment of diversion colitis with short-chain-fatty acid irrigation. N Engl J Med. 1989; 320(1):23-8. DOI: 10.1056/NEJM198901053200105. View

HAAS P, Fox Jr T, Szilagy E . Endoscopic examination of the colon and rectum distal to a colostomy. Am J Gastroenterol. 1990; 85(7):850-4. View

Whelan R, Abramson D, Kim D, Hashmi H . Diversion colitis. A prospective study. Surg Endosc. 1994; 8(1):19-24. DOI: 10.1007/BF02909487. View

Rolandelli R, Saul S, Settle R, Jacobs D, Trerotola S, Rombeau J . Comparison of parenteral nutrition and enteral feeding with pectin in experimental colitis in the rat. Am J Clin Nutr. 1988; 47(4):715-21. DOI: 10.1093/ajcn/47.4.715. View

10.

Koruda M, Rolandelli R, Bliss D, Hastings J, Rombeau J, Settle R . Parenteral nutrition supplemented with short-chain fatty acids: effect on the small-bowel mucosa in normal rats. Am J Clin Nutr. 1990; 51(4):685-9. DOI: 10.1093/ajcn/51.4.685. View

11.

Murray F, OBrien M, Birkett D, Kennedy S, Lamont J . Diversion colitis. Pathologic findings in a resected sigmoid colon and rectum. Gastroenterology. 1987; 93(6):1404-8. View

12.

Kvietys P, Granger D . Effect of volatile fatty acids on blood flow and oxygen uptake by the dog colon. Gastroenterology. 1981; 80(5 pt 1):962-9. View

13.

Koruda M, Rolandelli R, Settle R, Zimmaro D, Rombeau J . Effect of parenteral nutrition supplemented with short-chain fatty acids on adaptation to massive small bowel resection. Gastroenterology. 1988; 95(3):715-20. DOI: 10.1016/s0016-5085(88)80019-2. View

14.

Ma C, Gottlieb C, HAAS P . Diversion colitis: a clinicopathologic study of 21 cases. Hum Pathol. 1990; 21(4):429-36. DOI: 10.1016/0046-8177(90)90206-k. View

15.

Grant N, Van Kruiningen H, Haque S, West A . Mucosal inflammation in pediatric diversion colitis: a quantitative analysis. J Pediatr Gastroenterol Nutr. 1997; 25(3):273-80. DOI: 10.1097/00005176-199709000-00006. View

16.

Roediger W . Role of anaerobic bacteria in the metabolic welfare of the colonic mucosa in man. Gut. 1980; 21(9):793-8. PMC: 1419533. DOI: 10.1136/gut.21.9.793. View

17.

Geraghty J, Talbot I . Diversion colitis: histological features in the colon and rectum after defunctioning colostomy. Gut. 1991; 32(9):1020-3. PMC: 1379042. DOI: 10.1136/gut.32.9.1020. View

18.

Kiely E, Ajayi N, Wheeler R, Malone M . Diversion procto-colitis: response to treatment with short-chain fatty acids. J Pediatr Surg. 2001; 36(10):1514-7. DOI: 10.1053/jpsu.2001.27034. View

19.

Rolandelli R, Koruda M, Settle R, Rombeau J . The effect of enteral feedings supplemented with pectin on the healing of colonic anastomoses in the rat. Surgery. 1986; 99(6):703-7. View

20.

Korelitz B, Cheskin L, Sohn N, SOMMERS S . The fate of the rectal segment after diversion of the fecal stream in Crohn's disease: its implications for surgical management. J Clin Gastroenterol. 1985; 7(1):37-43. DOI: 10.1097/00004836-198502000-00005. View