A Report of Ulcerative Colitis With Relapse on the Rectal Side of the Loop Sigmoid Colostomy and Not on the Oral Side

TL;DR

A patient with ulcerative colitis relapsed only on the rectal side of a colostomy, showing changes in gut microbiota linked to inflammation.

Contribution

Demonstrates localized microbiota changes in ulcerative colitis relapse after colostomy.

Findings

Inflammation occurred only on the rectal side of the colostomy.

Firmicutes levels were reduced in the inflamed distal intestine but conserved in the proximal intestine.

Microbiota composition recovered in the distal intestine after remission was induced.

Abstract

A patient who received a loop sigmoid colostomy was diagnosed with ulcerative colitis (pancolitis type) and treated with infliximab. Thereafter, he relapsed with intestinal inflammation only on the rectal side of the loop sigmoid colostomy and not on the oral side. Autologous fecal microbiota transplantation from the proximal intestine to the distal intestine was performed to treat the inflammation but was ineffective. He was treated with oral prednisolone and induced into remission. After analyzing fecal samples from the patient, we observed an alteration of the composition of the intestinal microbiota with intestinal inflammation, including a reduction of phylum Firmicutes in the inflamed distal intestine, whereas Firmicutes was conserved in the proximal non-inflamed intestine and recovered in the distal intestine after induction of remission. Thus, our results indicated that the inflammation was associated with an alteration of the intestinal microbiota.

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