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Hellström PM, Benno P, Malfertheiner P. Gastrointestinal bleeding in patients with Helicobacter pylori and dual platelet inhibition after myocardial infarction. Lancet Gastroenterol Hepatol 2021; 6:684-685. [PMID: 34391514 DOI: 10.1016/s2468-1253(21)00192-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Per M Hellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Peter Benno
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Malfertheiner
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany; Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Benno P, Norin E, Midtvedt T, Hellström PM. Therapeutic potential of an anaerobic cultured human intestinal microbiota, ACHIM, for treatment of IBS. Best Pract Res Clin Gastroenterol 2019; 40-41:101607. [PMID: 31594647 DOI: 10.1016/j.bpg.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 01/31/2023]
Abstract
By administering an anaerobic cultivated human intestinal microbiota (ACHIM) via upper gastrointestinal route using endoscopy we aimed to rectify intestinal dysbiosis and simultaneously achieve a treatment response in IBS patients. The study population fulfilled the Rome III IBS criteria and comprised 50 patients. During 10 days, patients recorded the irritable bowel syndrome symptom severity scale (IBS-SSS) along with the Bristol stool scale and number of stools/day. The enrolled patients were categorized as follows: 37 with diarrhea, 5 with constipation and 8 with mixed symptoms. The treatment response showed reduction in a majority of patients, 32 of which with 50-point reduction of IBS-SSS and 21 with a 100-point IBS-SSS reduction. The percentage improvement was 36 (23-49) and 28 (18-38) for women and men respectively. Short-chain fatty acids were not changed. We consider fecal microbiota transplantation in the form of ACHIM as an option for the future therapeutic armamentarium in IBS. REGISTERED TRIAL: www.clinicaltrials.gov NCT02857257.
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Affiliation(s)
- P Benno
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - E Norin
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - T Midtvedt
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - P M Hellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Benno P. [The national food agency's dietary advice is not suitable for patients with IBS]. Lakartidningen 2017; 114:EFFH. [PMID: 28140426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Benno P, Dahlgren AL, Befrits R, Norin E, Hellström PM, Midtvedt T. From IBS to DBS. J Investig Med High Impact Case Rep 2016; 4:2324709616648458. [PMID: 27231695 PMCID: PMC4871203 DOI: 10.1177/2324709616648458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/05/2016] [Indexed: 11/15/2022] Open
Abstract
Irritable bowel syndrome is a chronic gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the absence of organic disease. We present 2 cases where diarrhea-predominant irritable bowel syndrome occurred in association with earlier intestinal infection or antibiotic treatment. Both were successfully treated with instillation of an anaerobic cultivated human intestinal microbiota. Thereafter, they were symptom free for at least 12 months. We now introduce the term dysbiotic bowel syndrome covering cases where a disturbed intestinal microbiota is assumed to be present. We recommend that restoration of the dysbiotic gut microbiota should be first-line treatment in these conditions.
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Affiliation(s)
- Peter Benno
- Läkarhuset Hötorgscity, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
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Benno P, Befrits R, Berstad A, Dahlgren AL, Norin E, Midtvedt T. [Underlying dysbiosis may be the cause of some forms of IBS. Patients were free of symptoms after the administration of microbiota]. Lakartidningen 2015; 112:DF7I. [PMID: 26035536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Two cases of post-infectious IBS were successfully treated with transplantation of an anaerobic cultivated human intestinal microbiota. This suggests that a dysbiosis of the intestinal microbiota could be the culprit at least in some cases of IBS. Resetting the gut microbiota might be a possible solution for these patients that otherwise may face a life-long reduction in quality of life. Studies have suggested that conditions as varied as chronic constipation, metabolic syndrome, autoimmunity, asthma, cardiovascular disease and Crohn's disease may be caused by intestinal dysbiosis. If this is the case we would like to suggest a new term: Dysbiotic Bowel Syndrome (DBS).
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Affiliation(s)
- Peter Benno
- Endoskopienheten, Läkarhuset, Hötorgscity - Stockholm, Sweden Mag-tarmmottagningen, Endoskopienheten - Läkarhuset, Hötorget Stockholm, Sweden
| | - Ragnar Befrits
- Endoskopienheten, Läkarhuset, Hötorgscity - Stockholm, Sweden Endoskopienheten, Läkarhuset, Hötorgscity - Stockholm, Sweden
| | - Arnold Berstad
- Unger-Vetlesens Institutt, Lovisenberg Diakonale Sykehus - Oslo, Norway Unger-Vetlesens Institutt - Unger-Vetlesens Institutt Oslo, Norway
| | - Atti-La Dahlgren
- Division of International & Humanitarian Medicine, Geneva University Hospital - Geneve, Switzerland Division of International & Humanitarian Medicine - Geneva University Hospital Geneva, Switzerland
| | - Elisabeth Norin
- Inst Mikrobiologi Tumör & Cellbiologi - Stockholm, Sweden Inst Mikrobiologi Tumör & Cellbiologi - Stockholm, Sweden
| | - Tore Midtvedt
- Inst Mikrobiologi Tumör och Cell Biologi, Karolinska Institutet, - Stockholm, Sweden Inst Mikrobiologi Tumörbiologi & Cellbiologi - Karolinska Institutet Stockholm, Sweden
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Benno P, Befrits R, Norin E, Berstad A, Dahlgren AL, Midtvedt T, Hellström PM. Is irritable bowel syndrome a dysbiotic bowel syndrome? Microbial Ecology in Health & Disease 2015; 26:27637. [PMID: 26031675 PMCID: PMC4451089 DOI: 10.3402/mehd.v26.27637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Peter Benno
- Gastroenterology and Endoscopy Unit, Läkarhuset Hötorgscity, Stockholm, Sweden
- Department of Microbiology, Tumorbiology and Cellbiology, Karolinska Institutet, Stockholm, Sweden;
| | - Ragnar Befrits
- Gastroenterology and Endoscopy Unit, Läkarhuset Hötorgscity, Stockholm, Sweden
| | - Elisabeth Norin
- Department of Microbiology, Tumorbiology and Cellbiology, Karolinska Institutet, Stockholm, Sweden
| | - Arnold Berstad
- Unger-Vetlesens Institutt, Lovisenberg Diakonale Sykehus, Oslo, Norway
| | - Atti-La Dahlgren
- Department of Microbiology, Tumorbiology and Cellbiology, Karolinska Institutet, Stockholm, Sweden
- Division of International and Humanitarian Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Tore Midtvedt
- Department of Microbiology, Tumorbiology and Cellbiology, Karolinska Institutet, Stockholm, Sweden
| | - Per M Hellström
- Gastroenterology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Benno P, Dahlgren AL, Norin E, Midtvedt T. [Clostridium difficile--unfairly set in the corner?]. Lakartidningen 2012; 109:1775. [PMID: 23097893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Benno P, Bark J, Collinder E, Hellström PM, Midtvedt T, Norin E. Major alterations in metabolic activity of intestinal microflora in Crohn's disease. Scand J Gastroenterol 2012; 47:251-2. [PMID: 21916816 DOI: 10.3109/00365521.2011.615859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Benno P, Dahlgren AL, Midtvedt T. [Helicobacter pylori--a friend in need]. Lakartidningen 2011; 108:2232. [PMID: 22165187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Peter Benno
- institutionen for mikrobiologi, tumör- och cellbiologi (MTC), Karolinska institutet, Stockholm.
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Affiliation(s)
- Atti-La Dahlgren
- Division of International and Humanitarian Medicine, Geneva University Hospitals (HUG) , Geneva, Switzerland
| | - Peter Benno
- Department of Microbiology, Tumor and Cell Biology (MTC) Karolinska Institutet , Stockholm, Sweden
- Department of Gastroentereology, Läkarhuset Hötorgscity , Geneva, Sweden
| | - Tore Midtvedt
- Department of Microbiology, Tumor and Cell Biology (MTC) Karolinska Institutet , Stockholm, Sweden
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Benno P, Blomquist L, Ernberg I, Midtvedt T, Möllby R, Norin E. [Intestinal flora--the biggest organ of the body. Unstable ecosystem which can easily topple]. Lakartidningen 2010; 107:900-903. [PMID: 20432862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Benno P, Midtvedt T, Norin E, Zachrisson K. [Prebiotics is food for the intestinal flora--for good and bad]. Lakartidningen 2010; 107:904-906. [PMID: 20432863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Benno P, Ernberg I, Midtvedt T, Norin E, Zachrisson K. [Probiotics--friends or enemies of the intestine?]. Lakartidningen 2010; 107:907-909. [PMID: 20432864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Benno P, Alam M, Collinder E, Norin E, Midtvedt T. Faecal tryptic activity and excretion of urobilins in 573 healthy subjects living in Sweden, Norway and Scotland. Microbial Ecology in Health and Disease 2009. [DOI: 10.1080/08910600310020622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- P. Benno
- From the Microbiology and Tumorbiology Center, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - M. Alam
- From the Microbiology and Tumorbiology Center, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - E. Collinder
- From the Microbiology and Tumorbiology Center, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - E. Norin
- From the Microbiology and Tumorbiology Center, Karolinska Institute, SE-17177, Stockholm, Sweden
| | - T. Midtvedt
- From the Microbiology and Tumorbiology Center, Karolinska Institute, SE-17177, Stockholm, Sweden
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Benno P, Midtvedt K, Alam M, Collinder E, Norin E, Midtvedt T. Examination of intestinal conversion of cholesterol to coprostanol in 633 healthy subjects reveals an age- and sex-dependent pattern. Microbial Ecology in Health and Disease 2009. [DOI: 10.1080/08910600500519854] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Peter Benno
- Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden
| | | | - Mahbub Alam
- Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden
| | - Eje Collinder
- Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden
| | - Elisabeth Norin
- Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden
| | - Tore Midtvedt
- Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden
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Benno P. [Should we load the dosette with anti-cirrhotic pills?]. Lakartidningen 2006; 103:2763. [PMID: 17061326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Benno P, Alam M, Collinder E, Norin E, Midtvedt T. Faecal Tryptic Activity and Excretion of Urobilins in 573 Healthy Subjects Living in Sweden, Norway and Scotland. Microbial Ecology in Health & Disease 2003. [DOI: 10.3402/mehd.v15i4.7959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Our aim was to study the influence of sulphasalazine (SASP), olsalazine (ADS) and sulphapyridine (SP) on the cell kinetics of the intestinal epithelium in conventional rats. Groups of rats were treated with SASP, ADS or SP for 9 days. After an intraperitoneal injection of a metaphase blocker, the rats were killed and the jejunum, ileum and colon were examined in histological sections by means of the cumulative mitotic index (MI), growth fraction and number of cells in crypts and villi. SP increased both the MI in the jejunum, ileum and colon and the number of crypt cells (p < 0.05 vs controls). In contrast, SASP and ADS increased the MI only in the colonic epithelium (p < 0.05 vs controls). The growth fraction was essentially unaffected. Our results suggest that SASP, SP and ADS have a selective compartment-dependent proliferative action on the epithelium of the intestinal tract.
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Affiliation(s)
- P Benno
- Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden
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Nilsson A, Danielsson A, Löfberg R, Benno P, Bergman L, Fausa O, Florholmen J, Karvonen AL, Kildebo S, Kollberg B. Olsalazine versus sulphasalazine for relapse prevention in ulcerative colitis: a multicenter study. Am J Gastroenterol 1995; 90:381-7. [PMID: 7872274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the relapse-preventing effect and the frequency of adverse events of olsalazine and sulphasalazine in sulphasalazine-tolerant patients with ulcerative colitis. METHODS Patients in remission, with at least two episodes of active disease during the last 5 yr, were randomized to 2 g of sulphasalazine or 1 g of olsalazine daily and were followed for 6-18 months. Relapse rates in the two groups were compared using frequency and life-table analysis. Sixty-nine patients with proctitis, 140 with left-sided colitis, and 113 with subtotal or total colitis were evaluated. RESULTS In the intention-to-treat analysis, the failure rate (relapses plus withdrawals) was 54.7% in the olsalazine and 47.2% in the sulphasalazine group. In the per-protocol analysis excluding withdrawals, 44.7% relapsed in the olsalazine and 39.3% in the sulphasalazine group. Remission curves did not differ significantly, although at all time intervals the frequency of remission was slightly higher in the sulphasalazine group (p = 0.19 in the intention-to-treat analysis and p = 0.42 in the per-protocol analysis estimated by the log-rank test). Twelve patients (of whom five had diarrhea) in the olsalazine group versus eight patients in the sulphasalazine group discontinued the study because of side effects. CONCLUSION The relapse-preventing effect of olsalazine and sulphasalazine in sulphasalazine-tolerant patients did not differ. Furthermore, the tolerability of olsalazine, particularly concerning diarrhea, appears to be better than previously reported.
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Affiliation(s)
- A Nilsson
- Department of Medicine, Umeã Hospitals, Sweden
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Abstract
The aim of this study was to examine the microflora-associated characteristics (MACs) of faecal samples of patients with rheumatoid arthritis (RA) and to evaluate the actions of sulphasalazine (SASP) on these MACs. The conversion of cholesterol to coprostanol, the production of urobilinogen, the degradation of faecal tryptic activity (FTA) and of beta-aspartylglycine were measured in faecal samples from 19 patients treated with SASP and 21 patients not treated with this medication. A control group of 21 healthy subjects was sex- and age-matched with the untreated patients. The conversion of cholesterol to coprostanol showed a bimodal distribution. The frequency of high converters in patients without SASP treatment was higher than in healthy subjects (p < 0.05). Treatment with SASP markedly increased the FTA and reduced the urobilinogen values, as compared to the untreated patients (p < 0.05). Beta-aspartylglycine was not found in any faecal samples. The results indicate that patients with RA have an abnormal formation of coprostanol, which is ascribed to alterations in the function of the Eubacteria species. In patients with RA, SASP treatment induces disturbances in the metabolism of the microflora.
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Affiliation(s)
- P Benno
- Department of Internal Medicine, Danderyd Hospital, Sweden
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Abstract
The aim of the study was to examine microflora-associated characteristics in patients with inactive ulcerative colitis, receiving sulphasalazine, in relation to the spread of the disease. The conversion of cholesterol to coprostanol, the production of urobilinogen, and the degradation of tryptic activity (FTA) and beta-aspartylglycine were measured in faecal samples from patients with proctitis or left-sided or total ulcerative colitis and in age- and sex-matched controls. No significant differences in the results were observed in patients with various degrees of extension of inflammatory bowel disease. However, the coprostanol ratio and the urobilinogen level were lower and the FTA was higher in patients with colitis than in the controls (p < 0.05). Beta-aspartylglycine was not found in any faecal sample. The results indicate that patients with ulcerative colitis taking sulphasalazine have a microflora with abnormal metabolic characteristics.
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Affiliation(s)
- P Benno
- Dept. of Medicine, Danderyd Hospital, Sweden
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Leijonmarck CE, Benno P, Carlstedt-Duke B, Monsen U, Norin E, Poppen B, Saxerholt H, Midtvedt T. The function of the intestinal microflora in patients with ulcerative colitis before and after colectomy. Scand J Gastroenterol 1990; 25:585-93. [PMID: 1972811 DOI: 10.3109/00365529009095534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The function of the intestinal microflora was studied in patients with ulcerative colitis before and after colectomy. The following six microflora-associated characteristics (MACs) were investigated: formation of coprostanol and urobilinogen; degradation of mucin, water-soluble protein, and beta-aspartylglycine; and presence of faecal tryptic activity. In 12 unoperated patients without sulphasalazine as maintenance therapy the six MACs were similar to those in normal subjects. In 12 unoperated patients receiving sulphasalazine the formation of coprostanol and urobilinogen was significantly lower (p less than 0.01 and p less than 0.001, respectively) and the level of faecal tryptic activity was significantly higher (p less than 0.01) than in normal subjects. The functional capacity of the microflora in operated patients treated by colectomy combined with one of four surgical procedures (ileorectal anastomosis, ileoanal anastomosis with pelvic pouch, Kock's continent ileostomy, or conventional ileostomy) was disturbed with regard to all six MACs. The disturbance was most pronounced in patients with conventional ileostomy.
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