The effects of probiotics on barrier function and mucosal pouch microbiota during maintenance treatment for severe pouchitis in patients with ulcerative colitis

Authors

  • M. Persborn,

    1. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
    2. Department of Surgery, County Council of Östergötland, Linköping, Sweden
    3. Department of Surgery, Regional Hospital Eksjö, County Council of Jönköping, Eksjö, Sweden
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  • J. Gerritsen,

    1. Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
    2. Winclove Probiotics, Amsterdam, The Netherlands
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  • C. Wallon,

    1. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
    2. Department of Surgery, County Council of Östergötland, Linköping, Sweden
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  • A. Carlsson,

    1. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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  • L. M. A. Akkermans,

    1. Department of Surgery, University Medical Center, Utrecht, The Netherlands
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  • J. D. Söderholm

    Corresponding author
    1. Department of Surgery, County Council of Östergötland, Linköping, Sweden
    • Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Correspondence to:

Dr. J. D. Söderholm, Department of Clinical and Experimental Medicine,

Linköping University Hospital

SE-581 85, Linköping, Sweden.

E-mail: johan.d.soderholm@liu.se

Summary

Background

A total of 10–15% of patients with an ileoanal pouch develop severe pouchitis necessitating long-term use of antibiotics or pouch excision. Probiotics reduce the risk of recurrence of pouchitis, but mechanisms behind these effects are not fully understood.

Aim

To examine mucosal barrier function in pouchitis, before and after probiotic supplementation and to assess composition of mucosal pouch microbiota.

Methods

Sixteen patients with severe pouchitis underwent endoscopy with biopsies of the pouch on three occasions: during active pouchitis; clinical remission by 4 weeks of antibiotics; after 8 weeks of subsequent probiotic supplementation (Ecologic 825, Winclove, Amsterdam, the Netherlands). Thirteen individuals with a healthy ileoanal pouch were sampled once as controls. Ussing chambers were used to assess transmucosal passage of Escherichia coli K12, permeability to horseradish peroxidase (HRP) and 51Cr-EDTA. Composition and diversity of the microbiota was analysed using Human Intestinal Tract Chip.

Results

Pouchitis Disease Activity Index (PDAI) was significantly improved after antibiotic and probiotic supplementation. Escherichia coli K12 passage during active pouchitis [3.7 (3.4–8.5); median (IQR)] was significantly higher than in controls [1.7 (1.0–2.4); P < 0.01], did not change after antibiotic treatment [5.0 (3.3–7.1); P = ns], but was significantly reduced after subsequent probiotic supplementation [2.2 (1.7–3.3); P < 0.05]. No significant effects of antibiotics or probiotics were observed on composition of mucosal pouch microbiota; however, E. coli passage correlated with bacterial diversity (r = −0.40; P = 0.018). Microbial groups belonging to Bacteroidetes and Clostridium clusters IX, XI and XIVa were associated with healthy pouches.

Conclusions

Probiotics restored the mucosal barrier to E. coli and HRP in patients with pouchitis, a feasible factor in prevention of recurrence during maintenance treatment. Restored barrier function did not translate into significant changes in mucosal microbiota composition, but bacterial diversity correlated with barrier function.

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