Intraluminal irrigation with fibers improves mucosal inflammation and atrophy in diversion colitis

Abstract

Objective: We investigated the effect of irrigating the colorectal mucosa of patients with a colostomy using a solution of fibers.

Methods: Eleven patients (10 male and 1 female; mean age, 34 y; age range, 16-49 y) with loop colostomy due to trauma underwent endoscopic evaluation of the rectum and the proximal and distal mucosa from the colostomy. An endoscopic score (range, 0-10) was used to quantify the intensity of the inflammation at the mucosa. Biopsies were taken from the colostomy border and from the rectum. The mean crypt depth of the five best-oriented glands was registered. Then the diverted colorectal segment was irrigated with a solution containing 5% fibers (10 g/d) for 7 d. The patients underwent repeated endoscopic and biopsy procedures, and then the colostomy was closed.

Results: The endoscopic score was higher (P < 0.01) at the distal border (2, 0-5) and the rectum (4, 1-10) when compared with the proximal border (0, 0-1). After treatment, the score at the diverted colon (1, 0-2) diminished (P = 0.03). The macroscopic score of the rectum also decreased after the infusion (4, 1-10, versus 3, 0-4; P = 0.03). Crypt depth at the proximal mucosa was higher than at the diverted mucosa (301 +/- 36 microm versus 205 +/- 76 microm; P < 0.01). After treatment, crypt depth at the diverted mucosa (280 +/- 64 microm) increased (P = 0.03). The rectum mucosa did not change before and after the treatment.

Conclusion: Irrigation with fibers improves inflammation at the defunctionalized colon.