Ganglion Cell Density and Colonic Microbiome Profile in Pseudo-obstruction Syndrome: A Case Series

Abstract

Background: During clinical practice, it has been observed that cases of sigmoid volvulus can develop complications post-treatment corresponding to acute colonic pseudo-obstruction (ACPO) and chronic intestinal pseudo-obstruction (CIPO), with the acute form, also known as Ogilvie's syndrome, being more common. The cause and underlying mechanism for the development of these conditions are not fully understood. Although potential causes have been described in other studies, research focused on the status of ganglion cells and the patient's microbiome is limited. This study aims to contribute to the medical literature by examining the ganglion cell content and microbial diversity in six patients diagnosed with acute and chronic colonic pseudo-obstruction observed in patients from the high Andean region of southern Peru.

Case Presentation: The common background characterizing and grouping the reported cases is the previous sigmoidectomy for sigmoid volvulus, along with the presence of signs and symptoms of an acute and chronic functional obstructive condition. In all cases, the clinical diagnosis following the treatment of sigmoid volvulus was ACPO or CIPO. These diagnoses were confirmed by abdominal X-ray and tomography. A conservative medical treatment with Neostigmine was initiated. The lack of response to this treatment led to various surgical techniques being performed.

Conclusion: All patients presented with hypoganglionosis. According to microbiome analysis, in four of them, the predominant phylum was Firmicutes and the predominant enterotype was Prevotella. In the other two patients, a high percentage of Proteobacteria was observed, with Bacteroides as the predominant enterotype. The average Firmicutes/Bacteroidetes ratio was 4.9. Our study shows the existence of bacterial dysbiosis in two patients with colonic hypoganglionosis, which could be related to the pathophysiology of ACPO and CIPO. Additionally, we report alterations in the relative frequency of bacteria associated with flavonoid metabolism.