Study in Ileal Pouch Anal Anastomosis IPAA

Very few studies have described motor pattern in patients with IBD after surgery and with IPAA in par ticular. In a study of some years ago [96], our aim was to determine whether a meal induces specific motor patterns in longstanding IPAA. Nine patients (6M, 3F) aged 35-58 (median 49) years were studied 1-10 (median 6.8) years after ileostomy closure. Two had a W-pouch and seven had a J-pouch. None of the patients showed endoscopic findings of pouchitis; daily bowel movements were 2-6 (median 4.6). After at least 12 h of fasting, an 8-channel perfused catheter with an open central lumen was placed by means of a guide-wire inserted during a regular colonoscopy. Recording ports, 15 cm apart, were positioned such that four were in the proximal small bowel, three in the reservoir and one on the internal anal sphincter. After at least 1 h after colonoscopy, we recorded pressure signals for 120 min before the ingestion of a 1 000-Kcal meal with 40, 30 and 30% of lipids, proteins and carbohydrates respectively. Postprandial recording continued for a further 60 min. Small bowel and pouch contractile activity was characterized at rest by sequences of large, isolated contraction waves. Phase III of MMCs were recorded in 7 patients. However, they were not followed by quiescence phases (Phase I), entering the rhythmic contraction sequence. In two cases, MMCs propagated into the reservoir resulting in IAS relaxation (Fig. 1). A meal induced an immediate increase in amplitude and frequency of motor waves creating clusters of multiphasic contractions. The global motility index (area under the curve) in the ileoanal pouch increased from 397-794 (mean 590) and from 479-756 (mean 582) mm Hg-min/60 min in the two fasting periods to 621-1 710 (mean 863) postprandi-ally (p<0.04; Wilcoxon test for matched pairs). We concluded that: (1) the fasting activity is not characterized by the typical sequences of the interdigestive motor activity in patients with longstanding ileoanal pouch; (2) the presence of altered MMC phases suggests that motor activity in the proximal small bowel is modified as a result of reservoir creation; (3) a meal induces significant changes in motor activity in the ileoanal reservoir, suggesting that "colonic" motility patterns arises in the most distal tract of the gut.

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