The 'ileal brake' after ileal pouch-anal anastomosis

The aim of this study was to assess if infusion of oleic acid into the ileal pouch would slow gastric emptying and small-bowel transit, delay defecation, and increase plasma levels of enteroglucagon, neurotensin, or peptide YY in patients with colectomy and ileal pouch-anal anastomosis. Eight subjects with chronic ulcerative colitis who had undergone the operation were studied on 2 consecutive days. On 1 day, saline (154 mM NaCl) was infused into the ileal pouch, and on the other day emulsified oleic acid (152 mM) was infused. The subjects ate a 300-kcal mixed meal containing liquid labelled with 99mTc-DTPA. To assess small-bowel transit concurrently with gastric emptying, a second marker, 111In-DTPA, was instilled through a tube into the duodenum at the end of the meal. Transit of both markers was monitored scintigraphically. Infusion of oleic acid into the ileal pouch slowed gastric emptying and small-bowel transit, and delayed the time to defecation compared with saline infusion. Neither the ileal pouch infusion alone or the meal alone altered plasma levels of enteroglucagon, neurotensin, or peptide YY, but the combination of the oleic acid infusion and the meal increased the levels of all 3 hormones. It was concluded that an "ileal brake" on gastrointestinal transit is functional following ileal pouch-anal anastomosis. Oleic acid placed into the ileal pouch slowed gastrointestinal transit and delayed defecation, effects which may have clinical application. The mechanism mediating the ileal brake may in part be hormonal.