Short-chain fatty acids in the non-adapted and adapted pelvic ileal pouch

Adaptation to colonic conditions occurs in the bacterial flora and faecal short-chain fatty acids (SCFAs) of the pelvic ileal pouch.

Faecal SCFAs were studied in 14 J-pouch patients within 10 days after closure of the ileostomy (non-adapted pouch) and more than 6 months after ileostomy closure (adapted pouch).

Concentrations of faecal SCFAs were low in non-adapted pouches (mean +/- SE, 20.3 +/- 3.4 mmol/l), increasing to intermediate levels, 53.3 +/- 8.4 mmol/l, between 6 months and a year after ileostomy closure, and to 96.3 +/- 7.9 mmol/l, after more than a year of adaptation. Production of SCFAs in faecal homogenates was correspondingly low in non-adapted (6.3 +/- 2.0 mmol/l) compared with adapted pouches (32.0 +/- 3.6 mmol/l; p = 0.001) and could not be overcome by the addition of fermentable carbohydrates. Percentages of the predominant SCFAs (acetate, propionate, butyrate) were not affected by adaptation, nor were production and concentration of lactate. Stool volume decreased from 1019 +/- 134 to 603 +/- 77 ml/24 h (p = 0.02) during adaptation, sodium excretion decreased from 132 +/- 19 to 67 +/- 11 mmol/24 h (p = 0.02), and osmolality increased from 316 +/- 6 to 398 +/- 13 (p = 0.001). Excretions of carbohydrates, nitrogen, and potassium were not altered.

The bacterial production of SCFAs is low in non-adapted pouches, resulting in low concentrations of SCFAs comparable to concentrations found in conventional ileostomies. Pouch adaptation gradually increases SCFA production and concentration severalfold and reaches concentrations normally found in non-colectomized individuals after approximately 1 year.