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. 1996 Aug;39(2):226–230. doi: 10.1136/gut.39.2.226

Intestinal permeability in the ileal pouch.

M N Merrett 1, N Soper 1, N Mortensen 1, D P Jewell 1
PMCID: PMC1383303  PMID: 8991861

Abstract

BACKGROUND: Villous atrophy, mucin changes ('colonic metaplasia'), and chronic inflammation occur to varying degrees in all patients with ileal pouchanal anastomosis whereas acute inflammation (pouchitis) affects a subgroup of patients with prior ulcerative colitis. AIM: To measure epithelial barrier function looking for possible functional adaptation in ileal 'pouch' mucosa. PATIENTS: Patients with an ileal pouch prior to ileostomy closure (n = 12), functioning pouch (n = 14), pouchitis (n = 8), and ulcerative colitis (n = 12) were assessed. METHODS: 51Cr-EDTA was administered into the 'pouch' or rectum and urinary recovery over 24 hours was taken as an indication of permeability (barrier function). Histological analysis of 'pouch' biopsy specimens was undertaken. RESULTS: Mucosal permeability is decreased from median 9.4% (range 5.4% to 39.1%) to 1.4% (range 0.38% to 2.2%) after ileostomy closure (p < 0.002) with levels being negatively correlated with two histological parameters of colonic metaplasia-mucin changes (p = 0.03) and villous atrophy (p = 0.05). Pouchitis was associated with increased permeability 5.9% (1.9% to 19.5%) compared with healthy 'pouch' 1.4% (0.35 to 2.2%) (p < 0.006). CONCLUSION: Despite the presence of chronic inflammation in the mature 'pouch' functional adaptation with reduced permeability occurs in conjunction with colonic metaplasia.

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Selected References

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  1. Aabakken L. Cr-ethylenediaminetetraacetic acid absorption test. Methodologic aspects. Scand J Gastroenterol. 1989 Apr;24(3):351–358. doi: 10.3109/00365528909093059. [DOI] [PubMed] [Google Scholar]
  2. Behrens R. H., Szaz K. F., Northrop C., Elia M., Neale G. Radionuclide tests for the assessment of intestinal permeability. Eur J Clin Invest. 1987 Apr;17(2):100–105. doi: 10.1111/j.1365-2362.1987.tb02387.x. [DOI] [PubMed] [Google Scholar]
  3. Bjarnason I., O'Morain C., Levi A. J., Peters T. J. Absorption of 51chromium-labeled ethylenediaminetetraacetate in inflammatory bowel disease. Gastroenterology. 1983 Aug;85(2):318–322. [PubMed] [Google Scholar]
  4. Bjarnason I., Peters T. J., Veall N. A persistent defect in intestinal permeability in coeliac disease demonstrated by a 51Cr-labelled EDTA absorption test. Lancet. 1983 Feb 12;1(8320):323–325. doi: 10.1016/s0140-6736(83)91628-8. [DOI] [PubMed] [Google Scholar]
  5. Cope G. F., Heatley R. V. Cigarette smoking and intestinal defences. Gut. 1992 Jun;33(6):721–723. doi: 10.1136/gut.33.6.721. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. De Vos M., Cuvelier C., Mielants H., Veys E., Barbier F., Elewaut A. Ileocolonoscopy in seronegative spondylarthropathy. Gastroenterology. 1989 Feb;96(2 Pt 1):339–344. doi: 10.1016/0016-5085(89)91557-6. [DOI] [PubMed] [Google Scholar]
  7. Dozois R. R., Goldberg S. M., Rothenberger D. A., Utsunomiya J., Nicholls R. J., Cohen Z., Hultén L. A., Moskowitz R. L., Williams N. S. Restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis. 1986 Jan;1(1):2–19. doi: 10.1007/BF01648830. [DOI] [PubMed] [Google Scholar]
  8. Galandiuk S., Scott N. A., Dozois R. R., Kelly K. A., Ilstrup D. M., Beart R. W., Jr, Wolff B. G., Pemberton J. H., Nivatvongs S., Devine R. M. Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. Ann Surg. 1990 Oct;212(4):446–454. doi: 10.1097/00000658-199010000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hamilton I., Cobden I., Rothwell J., Axon A. T. Intestinal permeability in coeliac disease: the response to gluten withdrawal and single-dose gluten challenge. Gut. 1982 Mar;23(3):202–210. doi: 10.1136/gut.23.3.202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Katz K. D., Hollander D., Vadheim C. M., McElree C., Delahunty T., Dadufalza V. D., Krugliak P., Rotter J. I. Intestinal permeability in patients with Crohn's disease and their healthy relatives. Gastroenterology. 1989 Oct;97(4):927–931. doi: 10.1016/0016-5085(89)91499-6. [DOI] [PubMed] [Google Scholar]
  11. Kelly D. G., Phillips S. F., Kelly K. A., Weinstein W. M., Gilchrist M. J. Dysfunction of the continent ileostomy: clinical features and bacteriology. Gut. 1983 Mar;24(3):193–201. doi: 10.1136/gut.24.3.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Knobler H., Ligumsky M., Okon E., Ayalon A., Nesher R., Rachmilewitz D. Pouch ileitis--recurrence of the inflammatory bowel disease in the ileal reservoir. Am J Gastroenterol. 1986 Mar;81(3):199–201. [PubMed] [Google Scholar]
  13. Köhler L. W., Pemberton J. H., Zinsmeister A. R., Kelly K. A. Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis. Gastroenterology. 1991 Sep;101(3):679–684. [PubMed] [Google Scholar]
  14. Lerch M. M., Braun J., Harder M., Hofstădter F., Schumpelick V., Matern S. Postoperative adaptation of the small intestine after total colectomy and J-pouch-anal anastomosis. Dis Colon Rectum. 1989 Jul;32(7):600–608. doi: 10.1007/BF02554181. [DOI] [PubMed] [Google Scholar]
  15. Levin K. E., Pemberton J. H., Phillips S. F., Zinsmeister A. R., Pezim M. E. Role of oxygen free radicals in the etiology of pouchitis. Dis Colon Rectum. 1992 May;35(5):452–456. doi: 10.1007/BF02049401. [DOI] [PubMed] [Google Scholar]
  16. Madara J. L., Stafford J. Interferon-gamma directly affects barrier function of cultured intestinal epithelial monolayers. J Clin Invest. 1989 Feb;83(2):724–727. doi: 10.1172/JCI113938. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Madden M. V., Farthing M. J., Nicholls R. J. Inflammation in ileal reservoirs: 'pouchitis'. Gut. 1990 Mar;31(3):247–249. doi: 10.1136/gut.31.3.247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Maxton D. G., Bjarnason I., Reynolds A. P., Catt S. D., Peters T. J., Menzies I. S. Lactulose, 51Cr-labelled ethylenediaminetetra-acetate, L-rhamnose and polyethyleneglycol 400 [corrected] as probe markers for assessment in vivo of human intestinal permeability. Clin Sci (Lond) 1986 Jul;71(1):71–80. doi: 10.1042/cs0710071. [DOI] [PubMed] [Google Scholar]
  19. Merrett M. N., Mortensen N., Kettlewell M., Jewell D. O. Smoking may prevent pouchitis in patients with restorative proctocolectomy for ulcerative colitis. Gut. 1996 Mar;38(3):362–364. doi: 10.1136/gut.38.3.362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Milks L. C., Brontoli M. J., Cramer E. B. Epithelial permeability and the transepithelial migration of human neutrophils. J Cell Biol. 1983 May;96(5):1241–1247. doi: 10.1083/jcb.96.5.1241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Morris A. J., Howden C. W., Robertson C., Duncan A., Torley H., Sturrock R. D., Russell R. I. Increased intestinal permeability in ankylosing spondylitis--primary lesion or drug effect? Gut. 1991 Dec;32(12):1470–1472. doi: 10.1136/gut.32.12.1470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Mortensen N. Progress with the pouch--restorative proctocolectomy for ulcerative colitis. Gut. 1988 May;29(5):561–565. doi: 10.1136/gut.29.5.561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Moskowitz R. L., Shepherd N. A., Nicholls R. J. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis. 1986 Jul;1(3):167–174. doi: 10.1007/BF01648445. [DOI] [PubMed] [Google Scholar]
  24. Mulligan S. C., Masterson J. G., Devane J. G., Kelly J. G. Clinical and pharmacokinetic properties of a transdermal nicotine patch. Clin Pharmacol Ther. 1990 Mar;47(3):331–337. doi: 10.1038/clpt.1990.36. [DOI] [PubMed] [Google Scholar]
  25. Nasmyth D. G., Godwin P. G., Dixon M. F., Williams N. S., Johnston D. Ileal ecology after pouch-anal anastomosis or ileostomy. A study of mucosal morphology, fecal bacteriology, fecal volatile fatty acids, and their interrelationship. Gastroenterology. 1989 Mar;96(3):817–824. [PubMed] [Google Scholar]
  26. O'Connell P. R., Rankin D. R., Weiland L. H., Kelly K. A. Enteric bacteriology, absorption, morphology and emptying after ileal pouch-anal anastomosis. Br J Surg. 1986 Nov;73(11):909–914. doi: 10.1002/bjs.1800731121. [DOI] [PubMed] [Google Scholar]
  27. Pearson A. D., Eastham E. J., Laker M. F., Craft A. W., Nelson R. Intestinal permeability in children with Crohn's disease and coeliac disease. Br Med J (Clin Res Ed) 1982 Jul 3;285(6334):20–21. doi: 10.1136/bmj.285.6334.20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Pemberton J. H., Kelly K. A., Beart R. W., Jr, Dozois R. R., Wolff B. G., Ilstrup D. M. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg. 1987 Oct;206(4):504–513. doi: 10.1097/00000658-198710000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Pena J. P., Gemlo B. T., Rothenberger D. A. Ileal pouch-anal anastomosis: state of the art. Baillieres Clin Gastroenterol. 1992 Mar;6(1):113–128. doi: 10.1016/0950-3528(92)90022-7. [DOI] [PubMed] [Google Scholar]
  30. Persson P. G., Ahlbom A., Hellers G. Inflammatory bowel disease and tobacco smoke--a case-control study. Gut. 1990 Dec;31(12):1377–1381. doi: 10.1136/gut.31.12.1377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Phillips R. K. Pelvic pouches. Br J Surg. 1991 Sep;78(9):1025–1026. doi: 10.1002/bjs.1800780902. [DOI] [PubMed] [Google Scholar]
  32. Prytz H., Benoni C., Tagesson C. Does smoking tighten the gut? Scand J Gastroenterol. 1989 Nov;24(9):1084–1088. doi: 10.3109/00365528909089259. [DOI] [PubMed] [Google Scholar]
  33. Rauh S. M., Schoetz D. J., Jr, Roberts P. L., Murray J. J., Coller J. A., Veidenheimer M. C. Pouchitis--is it a wastebasket diagnosis? Dis Colon Rectum. 1991 Aug;34(8):685–689. doi: 10.1007/BF02050351. [DOI] [PubMed] [Google Scholar]
  34. SPICER S. S. DIAMINE METHODS FOR DIFFERENTIALING MUCOSUBSTANCES HISTOCHEMICALLY. J Histochem Cytochem. 1965 Mar;13:211–234. doi: 10.1177/13.3.211. [DOI] [PubMed] [Google Scholar]
  35. Schulzke J. D., Fromm M., Bentzel C. J., Menge H., Riecken E. O. Adaptation of the jejunal mucosa in the experimental blind loop syndrome: changes in paracellular conductance and tight junction structure. Gut. 1987;28 (Suppl):159–164. doi: 10.1136/gut.28.suppl.159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Shepherd N. A., Jass J. R., Duval I., Moskowitz R. L., Nicholls R. J., Morson B. C. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol. 1987 Jun;40(6):601–607. doi: 10.1136/jcp.40.6.601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Small intestinal bacterial overgrowth syndrome. Gastroenterology. 1981 Apr;80(4):834–845. [PubMed] [Google Scholar]
  38. Tobin M. V., Logan R. F., Langman M. J., McConnell R. B., Gilmore I. T. Cigarette smoking and inflammatory bowel disease. Gastroenterology. 1987 Aug;93(2):316–321. doi: 10.1016/0016-5085(87)91021-3. [DOI] [PubMed] [Google Scholar]
  39. Travis S., Menzies I. Intestinal permeability: functional assessment and significance. Clin Sci (Lond) 1992 May;82(5):471–488. doi: 10.1042/cs0820471. [DOI] [PubMed] [Google Scholar]
  40. Tytgat G. N., van Deventer S. J. Pouchitis. Int J Colorectal Dis. 1988 Nov;3(4):226–228. doi: 10.1007/BF01660720. [DOI] [PubMed] [Google Scholar]
  41. Zuccaro G., Jr, Fazio V. W., Church J. M., Lavery I. C., Ruderman W. B., Farmer R. G. Pouch ileitis. Dig Dis Sci. 1989 Oct;34(10):1505–1510. doi: 10.1007/BF01537101. [DOI] [PubMed] [Google Scholar]
  42. de Silva H. J., Gatter K. C., Millard P. R., Kettlewell M., Mortensen N. J., Jewell D. P. Crypt cell proliferation and HLA-DR expression in pelvic ileal pouches. J Clin Pathol. 1990 Oct;43(10):824–828. doi: 10.1136/jcp.43.10.824. [DOI] [PMC free article] [PubMed] [Google Scholar]

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