ESTUDO DA MUCOSA ENTERALDE RESERVATÓRIOS EM J EM CÃES

Total proctocolectomy with enteral reservoir is, at present, the best technique used for the surgical treatment of some large intestine diseases involving the whole colon. In order to study the characteristics of the J reservoir enteral mucosa, thirty-six dogs underwent surgery. After resection of 5cm of the jejunum caudalis the animals were divided into two equal groups (GI and GII) for study-control. In GI, an entero-enteral end-to-end anastomosis was performed; in GII, a J reservoir was performed in the cranialis segment of the jejunum and this pouch was anastomosed end-to-end to the jejunun caudalis (similar to GI). On the 21st, 42nd and 63rd postoperative days, six animals of each group were sacrificed for macro and microscopic studies, including cellular counting and the measuring of the enteral mucosa lamina propria. On the 21st day, both groups showed oedema and erythema on macroscopic examination, and necrosis under microscopy in similar numbers. On the 42nd and 63rd days, these alterations decreased or disappeared in GI and persisted in GII. Only in the latter group, on macroscopy, ulcers were observed on the 21st day (2 dogs) and on the 42nd day (1 dog). In both groups there was no significant difference as to the incidence of abscess under microscopy. On the 21st day there was an increase of the volumetric density of neutrophils polymorph, macrophages, eosinophils, plasma cells and lymphocites in both groups. All the cells, except the eosinophils, showed a significant enlargement of the volumetric density in GII on the 63rd day. The transversal diameter of lamina propria, except for the villi height, was significantly larger in GII on the 63rd postoperative day. It was concluded that the enteral mucosa of the J reservoir in dogs shows alterations of the normal pattern of macroscopy and microscopy, including the volumetric density enlargement of the inflammatory cells.A proctocolectomia total com reservatório enteral é a principal técnica utilizada para o tratamento operatório de algumas doenças do intestino grosso. Com o objetivo de estudar as características da mucosa enteral de reservatórios em J, foram operados 36 cães. Após a ressecção de 5 cm do jejunum caudalis, para estudo-controle, os cães foram separados em dois grupos (GI e GII). No GI, foi realizada anastomose êntero-enteral término-terminal; no GII, foi feito um reservatório na forma de J no segmento cranialis, que foi anastomosado ao segmento caudalis da mesma forma que no GI. Aos 21, 42 e 63 dias de pós-operatório, foi realizada eutanásia de 6 cães de cada grupo para estudos macroscópico e microscópico, incluindo-se contagens celulares e medidas da lâmina própria da mucosa enteral. Os resultados revelaram, aos 21 dias, edema e enantema, à macroscopia, e necrose à microscopia, em freqüências semelhantes nos dois grupos. Aos 42 e 63 dias, essas alterações diminuiram ou desapareceram no GI e persistiram no GII. Somente neste último foram observadas úlceras à macroscopia aos 21 dias (2 cães) e 42 dias (1 cão). Não houve diferença significante à presença de abscesso, à microscopia, nos dois grupos. Na contagem celular, já aos 21 dias houve aumento da densidade volumétrica de neutrófilos, macrófagos, eosinófilos, plasmócitos e linfócitos nos dois grupos. Todas as células, exceto eosinófilos, apresentavam-se com densidade volumétrica significantemente maior no GII, aos 63 dias. O diâmetro transversal da lâmina própria, excluindo a altura dos vilos, apresentou-se significantemente maior no GII aos 63 dias de pós-operatório. Concluiu-se que a mucosa enteral de reservatórios em J, em cães, apresenta modificações do padrão de normalidade macroscópica e microscópica, entre as quais o aumento da densidade volumétrica de células inflamatórias.PUCCAMPUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Clinical and laboratory studies of the bacterial pathogenesis and management of Pouchitis

20-50% of patients develop pouchitis following restorative proctocolectomy for ulcerative colitis (UC). Pre-pouch ileitis (PPI) also develops in some of these patients. Bacteria are implicated in the pathogenesis of pouchitis and antibiotics are the mainstay of treatment. Studies were performed to examine the role of bacteria in the pathogenesis of this disease and to develop new treatment. Further studies examined the prevalence and implications of PPI and the efficacy and complications associated with maintenance antibiotic therapy. 16s rRNA sequencing demonstrated an increase in Proteobacteria and a reduction in Bacteroidetes in the UC compared with the familial adenomatous polyposis (FAP) cohort, but only limited differences between the UC non-pouchitis and pouchitis groups. We were unable to identify an individual species or phylotype specifically associated with pouchitis. Treatment with elemental diet produced a symptomatic improvement in 71% of chronic pouchitis patients but none entered clinical remission. Patients with PPI were identified, the prevalence, symptoms and short term outcomes of this group were studied. PPI was identified in 5.7% of patients with UC. All patients had associated pouchitis but not all were symptomatic. PPI was not associated with reclassification to Crohn’s disease. A subgroup of patients with symptomatic pre-pouch ileitis were treated with combination antibiotic therapy and 86% entered remission. Faecal samples from patients with antibiotic resistant pouchitis were grown on agar and sensitivity patterns identified. Following guided antibiotic therapy 80% of patients entered remission. Stool analysis also identified the presence of extended spectrum beta-lactamase (ESBL) resistant coliforms in 35% of patients with chronic pouchitis. Not all were symptomatic. PPI was associated with an increased risk of ESBL. Patients treated with maintenance antibiotic therapy were identified. Pre-pouch ileitis was associated with an increased risk of relapse. Reported side effects were rare and treatment was associated with an improved quality of life