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Effect of butyrate enemas on gene expression profiles and endoscopic/histopathological scores of diverted colorectal mucosa: a randomized trial

Digestive and Liver Disease, In Press, Accepted Manuscript, Available online 28 September 2015, January 1970

Abstract

Background

A temporary stoma is often created to protect a distal anastomosis in colorectal surgery. Short-chain fatty acids, mainly butyrate, are the major fuel source for the epithelium and their absence in the diverted tract may produce mucosal atrophy and inflammation, Aims: To investigate whether the administration of sodium butyrate enemas (Naburen©, Promefarm, Italy) could prevent mucosal inflammation and atrophy and affect gene expression profiles after ileo/colostomy.

Methods

We performed a randomized, double-blind, placebo-controlled clinical trial, in patients with enterostomy performed for inflammatory bowel disease, colorectal cancer or diverticulitis. Twenty patients were randomly allocated to receive 30 ml of sodium butyrate 600 mmol/L (group A) or saline (group B), b.i.d. for 30 days.

Results

In group A endoscopic scores were significantly improved (P < 0.01) while mucosal atrophy was reduced or unchanged; in group B mucosal atrophy was increased in 42.8% of patients. Despite the high dose of butyrate used, no short-chain fatty acids were detectable by gas chromatography-mass spectrometry in colorectal biopsies. Group A patients showed up-regulation of genes associated with mucosal repair such as Wnt signaling, cytoskeleton regulation and bone morphogenetic protein-antagonists.

Conclusion

Butyrate enemas may prevent the atrophy of the diverted colon/rectum, thus improving the recovery of tissue integrity.

Keywords: diversion colitis, topic butyrate, gene expression profiles, bone morphogenetic protein (BMP) antagonists, inflammatory bowel disease..

Footnotes

a Department of Neurofarba, University of Florence, Italy

b Department of Surgery and Translational Medicine, University of Florence, Italy

c Unit of Anatomy, Histology and Pathological Cytodiagnosis, S. Giovanni di Dio Hospital, Florence, Italy

Corresponding author. Dept. of Neurofarba, section of Pharmacology and Toxicology, University of Florence, Viale Pieraccini 6, 50139 Florence; Tel.: +390554271320; fax: +390554271280