Skip to main content
NCBI home page
Gut logoLink to Gut
. 1997 Jun;40(6):790–793. doi: 10.1136/gut.40.6.790

Contribution of gastrointestinal transit and pouch characteristics in determining pouch function.

P A Goldberg 1, M A Kamm 1, R J Nicholls 1, G Morris 1, K E Britton 1
PMCID: PMC1027205  PMID: 9245934

Abstract

AIM: To determine the contributions of gastrointestinal transit and pouch characteristics to bowel frequency in patients with an ileoanal reservoir and no pouchitis. METHODS: Twenty one patients who had undergone restorative proctocolectomy, with ileostomy closure at least eight months previously, and who had no history of pouchitis were recruited. They were prospectively classified on the basis of their bowel frequency: 11 patients had good pouch function (bowel frequency less than six per day) and 10 had poor function (bowel frequency more than six per day). Gastrointestinal transit was studied using a dual isotope technique and anal and pouch physiological examination was performed on all patients. RESULTS: Lag phase, 25% and 50% gastric emptying, small bowel transit time, and 10% and 50% pouch filling times, all for solids and liquids, were not significantly different between patients with good and poor function. Anal manometry and pouch and anal electrical sensitivity were also similar in the two groups. The volume of air and water required to elicit an initial sensation and the urge to defaecate were similar in both groups, but the maximum tolerated volume to both air (525 v 245 ml, good v poor function, median values) and water (625 v 370 ml) infusion was significantly (both p < 0.02) lower in patients with poor function. CONCLUSION: Maximum tolerated volume in the pouch, which may reflect pouch size, sensitivity, compliance, or a combination of these is the major determinant of pouch function. Gastrointestinal transit does not seem to be an important determinant of function.

Full text

PDF
790

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Groom J. S., Kamm M. A., Nicholls R. J. Relationship of small bowel motility to ileoanal reservoir function. Gut. 1994 Apr;35(4):523–529. doi: 10.1136/gut.35.4.523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Kamm M. A., Lennard-Jones J. E. Rectal mucosal electrosensory testing--evidence for a rectal sensory neuropathy in idiopathic constipation. Dis Colon Rectum. 1990 May;33(5):419–423. doi: 10.1007/BF02156270. [DOI] [PubMed] [Google Scholar]
  3. Levitt M. D., Kamm M. A., Groom J., Hawley P. R., Nicholls R. J. Ileoanal pouch compliance and motor function. Br J Surg. 1992 Feb;79(2):126–128. doi: 10.1002/bjs.1800790210. [DOI] [PubMed] [Google Scholar]
  4. Mather S. J., Ellison D., Nightingale J., Kamm M., Britton K. E. The design of a two-phase radiolabelled meal for gastric emptying studies. Nucl Med Commun. 1991 May;12(5):409–416. doi: 10.1097/00006231-199105000-00005. [DOI] [PubMed] [Google Scholar]
  5. McIntyre P. B., Pemberton J. H., Wolff B. G., Beart R. W., Dozois R. R. Comparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Dis Colon Rectum. 1994 Apr;37(4):303–307. doi: 10.1007/BF02053588. [DOI] [PubMed] [Google Scholar]
  6. Nicholls R. J., Lubowski D. Z. Restorative proctocolectomy: the four loop (W) reservoir. Br J Surg. 1987 Jul;74(7):564–566. doi: 10.1002/bjs.1800740705. [DOI] [PubMed] [Google Scholar]
  7. Nicholls R. J., Moskowitz R. L., Shepherd N. A. Restorative proctocolectomy with ileal reservoir. Br J Surg. 1985 Sep;72 (Suppl):S76–S79. doi: 10.1002/bjs.1800721341. [DOI] [PubMed] [Google Scholar]
  8. Nicholls R. J., Pezim M. E. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br J Surg. 1985 Jun;72(6):470–474. doi: 10.1002/bjs.1800720622. [DOI] [PubMed] [Google Scholar]
  9. Rogers J., Laurberg S., Misiewicz J. J., Henry M. M., Swash M. Anorectal physiology validated: a repeatability study of the motor and sensory tests of anorectal function. Br J Surg. 1989 Jun;76(6):607–609. doi: 10.1002/bjs.1800760628. [DOI] [PubMed] [Google Scholar]
  10. Scott N. A., Pemberton J. H., Barkel D. C., Wolff B. G. Anal and ileal pouch manometric measurements before ileostomy closure are related to functional outcome after ileal pouch-anal anastomosis. Br J Surg. 1989 Jun;76(6):613–616. doi: 10.1002/bjs.1800760630. [DOI] [PubMed] [Google Scholar]
  11. Setti-Carraro P., Ritchie J. K., Wilkinson K. H., Nicholls R. J., Hawley P. R. The first 10 years' experience of restorative proctocolectomy for ulcerative colitis. Gut. 1994 Aug;35(8):1070–1075. doi: 10.1136/gut.35.8.1070. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES