Cicatrização de anastomoses do cólon esquerdo com doença inflamatória: estudo experimental em ratos Healing of the left colon anastomosis with inflammatory bowel disease: experimental study in rats

Complicações relacionadas com a anastomose são descritas com freqüência nas cirurgias para o tratamento da doença inflamatória do cólon. Para conhecer a interferência da inflamação na cicatrização de anastomoses 40 ratos Wistar são utilizados e divididos em 2 grupos. Um deles serviu de controle e no outro induziu-se doença inflamatória com ácido acético 10% por sondagem retal. No sétimo dia procedeu-se à laparotomia em ambos os grupos, colotomia e anastomose término-terminal com pontos separados em plano único. Avaliadas no terceiro e sétimo dias, pode-se verificar que o número de complicações no grupo de animais com doença inflamatória foi maior assim como a mortalidade. As deiscências com peritonite foi a situação mais comum (p=0,0222). A capacidade de suportar pressão, nas anastomoses que evoluíram sem complicações foi menor nestes cólons, porém a diferença quando comparada ao controle não foi significante (p=0,0836). Verificou-se que as anastomoses construídas em cólons com doença inflamatória apresentavam maior concentração de colágeno total, com predomínio de colágeno imaturo (tipo III) (p=0,0000) enquanto que nas feitas em cólons normais predominava colágeno maduro (tipo I) (p=0,0102). Observou-se ainda que a organização do colágeno era menor, no terceiro dia, nas anastomoses com doença inflamatória. Entretando a análise da reação inflamatória ao nível da anastomose foi semelhante nos dois grupos. Estes resultados permitem sugerir que a doença inflamatória leva a aumento do número de deiscências provavelmente pelo atraso da maturação e ordenação do colágeno.<br>Complications related to anastomosis failure are frequently described in the surgery of inflammatory bowel disease. The aim of the present study was to evaluated colonic wound healing in an inflamed bowel. Forty Wistar rats were divided in 2 groups: the control and experimental groups. In the experimental group, colitis was induced by the infusion of 10% acetic acid per rectum to understand how inflammation interferes with the healing process of intestinal. On the7th post-operative day an end to end colonic anastomosis was performed with interrupted suture. On the 3rd and 7th post-operative days, the anastomosis were evaluated. We observed that mortality and the number of complications were greater in the group of animals with inflammatory bowel disease. Dehiscence with peritonitis was the most common complication(p=0.0222). The bursting strength in the colons without leakage was lesser than those in the control group, however this difference was not statistically significant (p=0,0836). It was verified that the anastomosis performed in colons with inflammatory bowel disease showed greater total collagen concentration, with a predominance of immature collagen (type III) (p=0.0000). The mature collagen (type I) was the predominant collagen in the wounds of normal colon. (p=0.0102). On the 3th post-operative day It was also observed that the organization of collagen was poorer on the third day in the colonic wounds with inflammatory bowel disease. Nevertheless, the analysis of the inflammatory reaction at the level of the anastomosis was similar in both groups. These results suggest that inflammatory bowel disease increases the risks of anastomosis dehiscence, probably because of the delay in the maturation and the organisation of collagen

Numerical ecology validates a biogeographical distribution and gender-based effect on mucosa-associated bacteria along the human colon

We applied constrained ordination numerical ecology methods to data produced with a human intestinal tract-specific phylogenetic microarray (the Aus-HIT Chip) to examine the microbial diversity associated with matched biopsy tissue samples taken from the caecum, transverse colon, sigmoid colon and rectum of 10 healthy patients. Consistent with previous studies, the profiles revealed a marked intersubject variability; however, the numerical ecology methods of analysis allowed the subtraction of the subject effect from the data and revealed, for the first time, evidence of a longitudinal gradient for specific microbes along the colorectum. In particular, probes targeting Streptococcus and Enterococcus spp. produced strongest signals with caecal and transverse colon samples, with a gradual decline through to the rectum. Conversely, the analyses suggest that several members of the Enterobacteriaceae increase in relative abundance towards the rectum. These collective differences were substantiated by the multivariate analysis of quantitative PCR data. We were also able to identify differences in the microarray profiles, especially for the streptococci and Faecalibacterium prausnitzii, on the basis of gender. The results derived by these multivariate analyses are biologically intuitive and suggest that the biogeography of the colonic mucosa can be monitored for changes through cross-sectional and/or inception cohort studies