Evolution of the Microbiome in a Pelvic Pouch Model: A Prospective Study to Understand Mechanisms of Ileal Inflammation

Details of Research

Contact: Joanne Stempak, Project Manager
416-586-4800 ext 8399
Joanne.Stempak@SinaiHealth.ca

Primary Investigator: Mark Silverberg, MD
Enrolment: Ongoing 

Sponsor: Crohn’s and Colitis Canada

Objective: To examine the evolution of the microbiome in the pouch, and its association with pouch inflammation. Patients with Familial Adenomatous Polyposis (FAP) will serve as a control population. This will provide insight on how microbial and genetic factors may be causative in the intestinal inflammation of patients with IBD.

Eligibility: Any Mount Sinai Hospital (MSH) patient who has a confirmed diagnosis of Ulcerative Colitis or Familial Adenomatous Polyposis and is expected to undergo (or recently underwent) a pelvic pouch surgery with an ileostomy at some point.

You are not eligible for this study if:

• You have been diagnosed with Crohn’s Disease
• You were prescribed to take a long-term antibiotic or immunomodulatory therapy following pouch surgery
• You have previously had “backwash” ileitis

Participation:

Participation involves:  

• Providing us with information regarding your family history and disease specifics
• A small blood sample for research purposes
• Providing us with permission to review your medical information regarding IBD
• Filling in 4-day food diaries and food frequency questionnaires prior to your sample collections
• Allowing us to follow you from pouch creation for up to 24 months after your ileostomy closure with data and samples collected at the time of your checkups with the gastroenterologist or surgeon. 
• Providing tissue biopsies for research purposes during your colonoscopy.

Background information:
For many UC patients with severe inflammation, the surgical treatment which removes the large bowel and creation of the pouch from the end of the small intestine, has been considered a cure for UC. However, some patients develop inflammation within the pouch (“pouchitis”). Pouchitis occurs in the small intestine despite the fact that the previous, surgically cured illness (UC) was an inflammatory process confined exclusively to the large intestine. Symptoms of pouchitis include increased stool frequency and urgency, liquid consistency of stool, abdominal cramps and bleeding. Pouchitis occurs after the ileostomy closure and when the pouch is fully in function. This suggests that microbial factors may play a role in the inflammation. Additionally, pouchitis occurs more often in patients with UC than in patients with FAP, who have had the same procedure.  This suggests that there is also a genetic component to inflammation. 

Pouchitis is, therefore, an ideal model for studying the genetic, environmental, and microbial factors involved in new-onset ileal inflammation in individuals thought to have been rendered free of disease via surgical removal of the colon.

We would like to sincerely thank all of our study participants. This research couldn't be possible without your cooperation.

Please contact Joanne Stempak (phone 416-586-4800 x8399) if you are interested in participating in this study.