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Gastric emptying function after ileal J pouch-anal anastomosis for ulcerative colitis
Ryouichi Tomita1, Shigeru Fujisaki, Katsuhisa Tanjoh
1Department of Surgery, Nippon Dental University School of Dentistry at Tokyo, Tokyo, Japan.
Background:
Little is known of the effects on gastric function after ileal J pouch-anal anastomosis (IPAA) for ulcerative colitis. This study aimed to determine whether patients with postoperative high stool frequency after IPAA exhibit impaired gastric function.
Methods:
Gastric emptying time (GET) for a solid diet (rice gruel) with the use of a radioisotope method and for a liquid diet (orange juice) with the use of an acetaminophen method were assessed in 36 patients with ulcerative colitis more than 30 months after closure of protective ileostomy. Patients were divided into 2 groups: 18 patients with stool frequency less than 6 per day (group A) and 18 patients with stool frequency more than 7 per day (group B). GET for solid and liquid diets in groups A and B were compared with those in 18 healthy volunteers (group C). We correlated the time of peak blood concentration of acetaminophen (TPBCA) and both individual stool frequency per day and the length of distal ileum removed.
Results:
GET for the solid diet in groups A and B was not altered by IPAA compared with group C. GET for the liquid diet in groups A and B was slower than in group C (P<.0001). GETs for the liquid diet at 60 minutes or more in group A were slower than in group B (P<.0001); TPBCA was longer in group A than in groups B or C (P<.01). There were inverse correlations between TPBCA and individual stool frequency per day and between TPBCA and length of distal ileum removed (P<.001).
Conclusions:
Rapid transit from the stomach of the liquid diet in group B compared with group A may influence high stool frequency after IPAA. Our results suggested that, to obtain an adequate stool frequency after IPAA, the length of distal ileum removal should be less than 15 cm.