Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis.

OBJECTIVE: Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. Additionally, one rare but potential complication is the development of adenocarcinoma of the reservoir. The aim of this study was to evaluate the most frequently observed histopathological changes in ileal pouches and to correlate these changes with potential risk factors for complications. METHODS: A total of 41 patients were enrolled in the study and divided into the following three groups: a non-pouchitis group (group 1) (n = 20; 8 males; mean age: 47.5 years) demonstrating optimal outcome; a pouchitis without antibiotics group (group 2) (n = 14; 4 males; mean age: 47 years), containing individuals with pouchitis who did not receive treatment with antibiotics; and a pouchitis plus antibiotics group (group 3) (n = 7; 3 males; mean age: 41 years), containing those patients with pouchitis who were administered antibiotics. Ileal pouch endoscopy was performed, and tissue biopsy samples were collected for histopathological analysis. RESULTS: Colonic metaplasia was found in 15 (36.6%) of the 41 patients evaluated; of these, five (25%) were from group 1, eight (57.1%) were from group 2, and two (28.6%) were from group 3. However, no correlation was established between the presence of metaplasia and pouchitis (p = 0.17). and no differences in mucosal atrophy or the degree of chronic or acute inflammation were observed between groups 1, 2, and 3 (p>0.45). Moreover, no dysplasia or neoplastic changes were detected. However, the degree of mucosal atrophy correlated well with the time of postoperative follow-up (p = 0.05). CONCLUSIONS: The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.

Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis

OBJECTIVE: Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. Additionally, one rare but potential complication is the development of adenocarcinoma of the reservoir. The aim of this study was to evaluate the most frequently observed histopathological changes in ileal pouches and to correlate these changes with potential risk factors for complications. METHODS: A total of 41 patients were enrolled in the study and divided into the following three groups: a non-pouchitis group (group 1) (n = 20; 8 males; mean age: 47.5 years) demonstrating optimal outcome; a pouchitis without antibiotics group (group 2) (n = 14; 4 males; mean age: 47 years), containing individuals with pouchitis who did not receive treatment with antibiotics; and a pouchitis plus antibiotics group (group 3) (n = 7; 3 males; mean age: 41 years), containing those patients with pouchitis who were administered antibiotics. Ileal pouch endoscopy was performed, and tissue biopsy samples were collected for histopathological analysis. RESULTS: Colonic metaplasia was found in 15 (36.6%) of the 41 patients evaluated; of these, five (25%) were from group 1, eight (57.1%) were from group 2, and two (28.6%) were from group 3. However, no correlation was established between the presence of metaplasia and pouchitis (p = 0.17). and no differences in mucosal atrophy or the degree of chronic or acute inflammation were observed between groups 1, 2, and 3 (p>0.45). Moreover, no dysplasia or neoplastic changes were detected. However, the degree of mucosal atrophy correlated well with the time of postoperative follow-up (p = 0.05). CONCLUSIONS: The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.

Influence of storage and heating on mother´s milk microbiota / Influência do armazenamento e aquecimento na microbiota do leite materno

ACKGROUND: There is a consensus among many authors that the newborn (NB) is particularly prone to infections of the gastrointestinal tract for multiple factors, such as the hypoxia and the artificial milk. These factors facilitate the abnormal bacterial colonization and promote a drawback in the destruction of the toxins of such bacterias.AIM: To identify the microorganisms in the breast milk, after its storage in the refrigerator at 4°C, as well as after heating and to relate the eventual clinical NB signs with the microbiologic laboratory results of the breast milk which was offered.METHODS: The samples collected contemplated the three phases of post-natal breast milk. In 16 cases, the colostrum type was obtained as yellowish milky secretion, up to the beginning of the second week after the birth. In 14 cases, the transition type was obtained as intermediate product of the mother's milk, between colostrum and the mature milk, between the 7th and the 15th day after the birth. In 14 cases, the mature type was obtained as a white opaque liquid, of light smell and sweet taste, from the 15th day after birth. The milk types obtained in the three presentations were subdivided according to the period of conservation and heating in the group colostrums, transition and mature.RESULTS: The microorganisms which did not present growth were: Salmonella sp, Molds/leavens and Pseudomonas aeruginosa. The total coliforms and fecal coliforms were observed. There was no significant microorganisms growth. The aerobic mesophiles, Staphilococcus aureus and Bacillus cereus were also observed. These microorganisms presented growth, but the NBs did not present damage in their clinical status...

RACIONAL: Existe consenso que os recém-natos são particularmente propensos a desenvolverem infecções gastrointestinais devido a múltiplos fatores dentre eles a hipóxia. Há facilidade de colonização anormal e destruição de bactérias com absorção de toxinas.OBJETIVO: Identificar micro-organismos no leite materno depois de estocado em refrigerador a 4°C e também depois do aquecimento, e pesquisar se os sinais laboratoriais encontrados teem alguma correlação clínica.MÉTODOS: As amostras coletadas contemplaram as três fases do leite materno. Em 16 casos, colostro foi obtido como amarelado até a segunda semana do nascimento. Em 14 casos o tipo transicional, entre colostro e leite maduro, ocorreu de sete e 15 dias depois do nascimento. Em 14 casos o leite maduro foi obtido também entre sete e 15 dias. Os diversos tipos foram subdivididos de acordo com o período de conservação e de aquecimento.RESULTADOS: Os micro-organismos que não cresceram foram: Salmonella sp, Molds/leavens e Pseudomonas aeruginosa. Foram observados coliformes totais e fecais. Não ocorreu crescimento bacteriano significativo. Cresceram mesófilos aeróbicos, Staphilococcus aureus e Bacillus cereus. Embora com esses crescimentos, não houve repercussão clínica nos recém-nascidos...

A novel sampling method for the investigation of gut mirobiota.

AIM: In order to characterize the qualitative and quantitative microorganisms in different sites of the lower digestive tract (LDT) in healthy volunteers, a specific technique was developed for collecting mucous of the distal ileum, colon and rectum. METHODS: A polyethylene tube was designed to go through the colonoscope channel with a No.8 French tube. In order to avoid internal contamination, the distal extremity was protected with a membrane of microfilm after being sterilized in ethilene oxid. To facilitate the aspiration of a precise volume, its interior was coated with silicone. One hundred microlliter (0.1 mL) sample of mucous was collected and transferred into an Eppenddorff tube containing nine hundred microlliter (0.9 mL) of VMGA-3 (viable medium of Goteborg). This procedure was repeated at each site of the LDT with a new sterilized catheter. RESULTS: All sites revealed the "non pathogenic" anaerobic bacteria Veillonella sp (average 10(5) colony forming units/mL-CFU/mL), allowing to conclude an environment of low oxidation-reduction potential (redox) in the LDT. It was also characterized the presence of Klebisiella sp with significant statistical predominance (SSP) in the ileum. Enterobacter sp was found with SSP in the sigmoid colon, Bacteroides sp non-pigmented (npg) and E.coli with SSP in the sigmoid colon and rectum, Enterococcus sp and Lactobacillus sp with SSP in the rectum, all in a mean concentration of 10(5) CFU/mL. CONCLUSION: This procedure is feasible and efficient and can point out a similar distribution of the aerobic and anaerobic bacteria with the presence of biological markers of normal microbiota in the LDT.

[Megaesophagus microbiota and carcinogenesis]. / Microbiota do megaesôfago e carcinogênese.

BACKGROUND: The risk of development of spin cell carcinoma of the esophagus is 33 times higher in patients with chagasic achalasia. It is possible that the production of N-nitroso compounds in the esophageal lumen by of bacterial action in the stasis liquid that reduce nitrates from diet into nitrites may play a role in this process. AIM: To analyze qualitatively and quantitatively the microbiota in chagasic megaesophagus with special attention to bacteria capable of transforming nitto reduction. PATIENTS: Fifteen patients (six men and nine women) were prospectively studied, with ages varying from 28 to 73 years. Patients were divided into three sub-groups according to Rezende et al. classification of esophageal dilation (grade I, grade II and grade III). METHOD: The sample collection was performed using a method specially developed to avoid contamination with microorganisms of the oral cavity and oropharynx, using a Levine catheter n 14 and a 7,5 oro-traqueal tube. RESULTS: Ninety three point three percent of the cultures were positive, with great bacterial variability and predominance of a variety of aerobic Gram-positive and anaerobic bacteria. The bacterial concentrations were generally more elevated in grade III in comparison to grade I and grade II. Among the microorganisms found, Staphylococcus sp, Corynebacterium sp, Peptostreptococcus sp e a Veillonella sp were those with the capability of nitrate reduction. CONCLUSION: It was concluded that patients with megaesophagus present some bacteria in the esophageal lumen that are able to reduce nitrates intro nitrites, an important step in the formation of N-nitroso compounds.

Microbiota do megaesôfago e carcinogênese / Megaesophagus microbiota and carcinogenesis

INTRODUÇAO: O risco de desenvolvimento de carcinoma esofágico em portadores de megaesôfago é 33 vezes superior ao da populaçäo em geral. Possível explicaçäo para este fenômeno poderia estar relacionada à produçäo de compostos N-nitrosos na luz do órgäo, a partir da transformaçäo de nitratos da dieta em nitritos, mediada por bactérias em suspensäo no líquido de estase e com o contato crônico destes carcinógenos com a mucosa esofágica. OBJETIVO: Analisar a microbiota esofágica em pacientes portadores de megaesôfago de etiologia chagásica, com especial atençäo para a presença de bactérias com capacidade de reduçäo de nitratos. CASUíSTICA: Foram estudados prospectivamente 15 pacientes portadores de megaesôfago chagásico com idades variando de 28 a 73 anos, sendo 9 do sexo feminino e 6 do sexo masculino, que foram divididos em 3 grupos iguais de 5, de acordo com o grau de dilataçäo do esôfago, segundo a classificaçäo de Rezende et al. (Grau I, Grau II e Grau III). MÉTODO: A coleta do líquido de estase para estudo microbiológico era realizada através de sonda de Levine nº 14, que era passada pela boca, por dentro de uma cânula de intubaçäo orotraqueal nº 7,5, mantendo-se sua extremidade escondida, a fim de evitar sua contaminaçäo. RESULTADOS: Foram obtidas 93,3 por cento de culturas positivas com grande variedade de microrganismos e predomínio de aeróbios Gram-positivos e anaeróbios. As concentrações de microrganismos foram tanto maiores, quanto maior o grau de dilataçäo do esôfago. Entre os microrganismos encontrados, o Staphylococcus sp, Corynebacterium sp, Peptostreptococcus sp e a Veillonella sp foram aqueles identificados como tendo a capacidade de reduçäo de nitratos a nitritos. CONCLUSÄO: No megaesôfago chagásico há bactérias na luz do órgäo com capacidade de reduçäo de nitratos da dieta, passo importante na produçäo de compostos N-nitrosos.

Megaesophagus microbiota: a qualitative and quantitative analysis.

Bacterial overgrowth in the esophageal lumen in patients with megaesophagus can be the cause of recurring pulmonary infections, infectious complications due to surgical or endoscopic procedures, and the development of dysplasia of the esophageal mucosa and cancer. Despite this, esophageal microbiota in the megaesophagus have never been studied. The aim of this study was to analyze qualitatively and quantitatively the microbiota in chagasic megaesophagus in comparison to the normal esophagus. Twenty-five patients (10 men and 15 women), ranging in age from 24 to 74 years (mean years), were prospectively studied from March to September 2000. Fifteen patients with chagasic megaesophagus were divided into three subgroups (n = 5 patients in each) according to the grade of esophageal dilation: MG1 = megaesophagus grade I; MG2 = megaesophagus grade II; and MG3 = megaesophagus grade III. Another group of 10 patients without esophageal disease served as a control group. Samples were collected using a method especially developed to avoid contamination with microorganisms of the oral cavity and oropharynx. In the control group, 40% of the cultures were positive with the genus Streptococcus predominating and concentrations varying from 10(1) to 10(2) colony-forming units/ml. In the megaesophagus group, 93.3% of the cultures were positive, with great variability in the bacteria and a predominance of various aerobic gram-positive bacteria (Streptococcus was most common) and anaerobic bacteria (Veillonella was most frequent) in concentrations that ranged from 10(1) to 10(5) colony-forming units/ml. The bacterial concentrations were generally more elevated in MG3 patients in comparison to MG1 and MG2 patients and the control group (P < 0.05). It was concluded that patients with megaesophagus have a variety of microbiota consisting mostly of aerobic gram-positive and anaerobic bacteria, in concentrations that varied according to the degree of esophageal dilation.

Dieta enteral em pacientes neurológicos hospitalizados: análise das complicaçöes e dos resultados nutricionais / Enteral tube feeding in hospitalized neurologic patients: analysis of complications and of nutritional results

Foram analisados 48 pacientes com moléstias neurológicas graves, de tratamento clínico ou cirúrgico, com patologias benignas e malignas, submetidos a alimentaçäo nasoenteral com dieta de formulaçäo conhecida por quatro semanas. A avaliaçäo nutricional inicial e semanal foi feita através de dados laboratoriais e antropométricos. As necessidades calóricas foram calculadas teoricamente e corrigidas para fatores de stress. Observou-se correlaçäo estatisticamente significante entre ingesta calórica e necessidade calórica a partir da segunda semana. No decorrer do mesmo período, observou-se a manutençäo dos parâmetros laboratoriais, piora da CMB, tendência a positividade do balanço nitrogenado. Diarréia ocorreu em 14,5% dos casos. O suporte nutricional enteral para pacientes neurológicos pode ser considerado eficaz na manutençäo do estado nutricional. Entretanto, por apresentar complicaçöes inerentes ao método e ao doente neurológico, necessita monitoraçäo diária e cuidadosa

Linfagectasia intestinal primária / Primary intestinal lynphangiectasis

Os autores relatam caso de linfangectasia intestinal primária em um menino de 14 anos de idade, diagnóstico alcançado após extenso estudo para diferenciar de outras patologias intestinais. Com a introduçäo de dieta identa de gordura e uso de triglicérides de cadeia média (C8 - C12) houve melhora evidente, a curto prazo dos sinais e sintomas derivados da má-absorçäo de ácidos graxos, o que favoreceu o desenvolvimento social e escolar do paciente; contudo näo houve melhora täo evidente de proteinemia, resultando internaçöes sucessivas no período das férias escolares para suporte alimentar com alimentaçäo enteral e parenteral

Preparo intestinal pela ingestäo de manitol a 10% / Intestinal preparation by mannitol 10% ingestion

Os autores relatam sua experiência no preparo de cólon pelo uso de manitol a 10% assciado à cloranfenicol e gentamicina por via parenteral. Foram estudados 104 pacientes e pelas vantagens observadas em relaçäo ao preparo convencional, os autores concluem que é um método que pode ser adotado como um meio eficaz de preparo do cólon. Por provocar uma diarréia osmótica, o esvaziamento intestinal é bom, tendo os autores obtido resultados excelente e bom em mais de 90% dos casos; os efeitos colaterais säo discretos desde que o preparo seja bem indicado e bem conduzido e a tolerância pelos doentes é melhor que com o método clássico