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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
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.
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.
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.
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..
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
© 2015 Published by Elsevier B.V.