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Title: The assessment of pouch dysbiosis and the role of therapeutics in the treatment of pouchitis
Author: Gonsalves, Simon Joseph
Awarding Body: University of Leeds
Current Institution: University of Leeds
Date of Award: 2012
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Pouchitis (inflammation of the pouch) is a common cause of poor function of the ileal pouch. This condition can be debilitating for patients and difficult to treat. The exact aetiology of pouchitis remains unknown. A bacterial dysbiosis within the pouch has been suggested as a causative factor. Previous clinical studies that have attempted to evaluate the role of bacteria in the development of pouchitis have presented differing conclusions. This may be due to variations in Uie methods used, the selection criteria of patients, types of specimens analysed. However, recent molecular studies support the hypothesis that a bacterial dysbiosis is present during pouchitis and have identified changes in the bacterial communities in patients with pouchitis. The presence of lactoferrin in the faeces can be used as a biomarker for intestinal inflammation. The IBD EZ VUE™ faecal lactoferrin test (TECHLAB, Inc., Blacksburg, Virginia, USA) was used to investigate whether lactoferrin levels could also be employed to accurately diagnose pouchitis. The test's ability to detect inflammation of the pouch after antibiotic therapy was also assessed. The data demonstrated that the test results correlated well with the pouch disease activity index in the diagnosis of inflammation of the pouch. At an assay concentration set to detect 7 iJg/dL of lactoferrin, the test had a sensitivity of 100% and specificity of 92% for the diagnosis of pouchitis. To determine specific microorganisms associated with pouchitis, a protocol was designed to assess the faecal flora of 17 patients with an ileal pouch. Best culture techniques were used to compare the faecal flora from subjects with a healthy pouch (n=11) with those subjects with pouchitis (n=6). This study aimed to remove the limitations of previous studies and test the hypothesis of dysbiosis. The results demonstrated that the broad and specific flora were similar between the two groups of patients. This study did not identify any candidate organisms associated with pouchitis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available