Serological Biomarkers and Diversion Colitis: Changes after Stimulation with Probiotics

Abstract

Diversion colitis is a non-specific inflammation of a defunctionalised segment of the colon after a temporary stoma has been performed. This inflammation is associated with an alteration of certain inflammatory serum markers. The aims of this study were, firstly, to evaluate the modification of inflammatory biomarkers after stimulation with probiotics prior to closure of the protective ileostomy. Secondly, to identify if a relationship could be established between the severity of diversion colitis and the alteration of inflammatory biomarkers in the blood. A prospective, randomized, double-blind, controlled study was conducted. Patients who underwent surgery for colorectal carcinoma with protective ileostomy between January 2017 and December 2018 were included, pending reconstructive surgery and with diversion colitis as diagnosis. The sample was randomly divided into a group stimulated with probiotics (SG) (n = 34) and a control group (CG) (n = 35). Histological and endoscopic changes were evaluated after stimulation, after restorative surgery and during the short-term follow-up after surgery, including the correlation with pro-inflammatory biomarkers in blood. As main findings, a significant decrease in C-reactive protein (CRP), Neutrophil/lymphocyte ratio (NLR ratio), and monocyte/lymphocyte ratio (LMR ratio) was observed in the SG versus the CG with a p < 0.001. A significant increase in transferrin values and in the platelet/lymphocyte ratio (PLR) was observed in the SG versus CG after stimulation with probiotics with a p < 0.001. A normalisation of CRP and transferrin levels was observed in the third month of follow-up after closure ileostomy, and NLR, LMR and PLR ratios were equal in both groups. Decreased modified Glasgow prognostic score was found in SG compared to CG after probiotic stimulation (p < 0.001). The endoscopic and histological severity of diversion colitis is associated with a greater alteration of blood inflammatory biomarkers. The stimulation with probiotics prior to reconstructive surgery promotes an early normalization of these parameters.

Keywords: C-reactive protein; Glasgow Pronostic Score; diversion colitis; efferent loop stimulation; inflammatory bowel disease; probiotics; serological biomarkers.

Figure 1

Flow-chart of patient selection. CRC: Colorectal Cancer; *: excluded patients with anastomotic leak.

Figure 2

Inflammatory biomarkers throughout the study. Probiotics stimulation changes in serological biomarkers. The levels of CRP (C-reactive protein), NLR (neutrophil-to-lymphocyte ratio), LMR (lymphocyte-to-monocyte ratio), PLR (platelet-to-lymphocyte ratio), and transferrin were modified by probiotic consumption after the stimulation phase (p < 0.001). The levels of CRP, NLR, LMR, PLR, and transferrin were similar after 3-month follow-up.