Prospective study of immunological factors in non-inflammatory bowel disease enterocutaneous fistulas

BMC Surgery

Study Protocol

Stella C Knight¹  Hafid O Al-Hassi¹  Carolynne J Vaizey²  Janindra Warusavitarne²  Mohammad R Ullah²  Goher Rahbour²  Simon M Gabe³  Ailsa L Hart³ 

[1] Antigen Presentation Research Group, Faculty of Medicine, Imperial College London, Northwick Park & St. Mark's campus, Watford Road, HA1 3UJ, Harrow, Middlesex, UK;Colorectal and Intestinal Failure Surgery, St. Mark's Hospital and Academic Institute Watford Road, HA1 3UJ, Harrow, Middlesex, UK;Department of Gastroenterology, St. Mark's Hospital and Academic Institute Watford Road, HA1 3UJ, Harrow, Middlesex, UK;

关键词: Inflammatory Bowel Disease;    Infliximab;    Inflammatory Bowel Disease Patient;    Fistula Tract;    Short Bowel Syndrome;   

DOI  :  10.1186/1471-2482-11-12

 received in 2011-04-18, accepted in 2011-05-27,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundEnterocutaneous fistulas (ECF) are debilitating and usually result following complex abdominal surgery. While there is an association with inflammatory bowel disease (IBD), a large number of fistulas occur after surgery not related to IBD. The consequences of ECF include short bowel syndrome and the need for long term parenteral nutrition.ECF can heal spontaneously and in the case of IBD can be cured by medical therapy in some instances. Those that do not resolve spontaneously have to be cured by surgery which is complex and associated with a high morbidity. It is not considered traditional treatment to use the same medical therapy as in IBD to cure ECF caused by other conditions.A small case series has reported three patients with persistent ECF not related to IBD to have healed following use of Infliximab which is the treatment commonly used for ECF caused by IBD. Infliximab acts by inhibiting the activity of the inflammatory cytokine TNF- alpha. It is not known if this cytokine is present in ECF tissue in the absence of IBD.The aim of this study is to demonstrate the presence of inflammatory markers in tissue surrounding non-IBD ECF and in particular to quantify the presence of the cytokine TNF- alpha. We hypothesise that TNF - alpha levels are raised in non-IBD ECF.Methods/DesignTissue and serum from ECF of IBD and non-IBD patients will be prospectively collected at St. Mark's Hospital Intestinal Failure Unit. The control group will consist of patients undergoing colonoscopy for bowel cancer screening, with normal findings. Biopsies of the terminal ileum will be obtained from this group during colonoscopy. The fistula tract and serum cytokine profiles of interleukins (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, TNF- alpha, IFN-y, MCP-1, EGF and VEGF will be assessed.DiscussionThis study aims to assess the presence or absence of TNF- alpha expression in the ECF tissue in non-IBD origin. If our hypothesis is correct we would then be able to study the use of the TNF- alpha inhibitor Infliximab as a therapeutic option in the treatment of non-IBD ECF. Secondary aims include assessing the spectrum of inflammatory cytokines and markers present in tissue and serum of non-IBD ECF when compared with IBD ECF and normal controls.Trial registrationISRCTN44000447

【 授权许可】

CC BY   
© Rahbour et al; licensee BioMed Central Ltd. 2011