MUCOSAL MORPHOLOGY, CELL-PROLIFERATION AND FECAL BACTERIOLOGY IN ACUTE POUCHITIS

A study was performed to investigate whether acute reservoir ileitis ( pouchitis) is associated with specific changes in mucosal morphology, crypt cell kinetics and faecal bacteriology in the ileal pouch. Forty- six patients were studied (ileal reservoir, 36; end ileostomy, ten) us ing clinical grading, sigmoidoscopy and biopsy; 24 patients with a res ervoir were restudied after therapy for 1 month with metronidazole 400 mg three times daily. An index of villus atrophy and crypt cell produ ction rate (CCPR) were determined in all biopsy material. Faecal bacte riology was assessed in 12 patients with a pouch before and after metr onidazole therapy. The mucosa of patients with pouchitis was associate d with a lower villus atrophy index (P = 0.052), a higher CCPR (P = 0. 03) and a higher grade of acute inflammation than that in those withou t pouchitis. There was no difference in faecal bacterial counts betwee n patients with and without pouchitis. A low atrophy index correlated with a high CCPR (P < 0.001), worse functional score (P < 0.001) and m ore severe pouch mucosal acute inflammation (P < 0.001), but not with faecal bacteriology. Following metronidazole therapy there was resolut ion of acute pouch inflammation, increased villus atrophy index (P = 0 .049), decreased CCPR (P = 0.049) but no differences in faecal bacteri al counts apart from Bacteroides species. These data show that metroni dazole therapy does not specifically alter the growth of common faecal bacteria in patients with pouchitis, apart from Bacteroides species. However, metronidazole causes resolution of the typical changes in pou ch mucosal morphology and crypt cell kinetics associated with pouchiti s.