Long-Term Followup of Patients with Active J-Reservoirs after Restorative Proctocolectomy for Ulcerative Colitis with regard to Reservoir Function, Mucosal Changes, and Quality of Life

Abstract

Objective. Study the functional results and mucosal changes in the ileal pouch after restorative proctocolectomy with J-reservoir for ulcerative colitis. Material and Methods. Followup study of 125 patients with J-reservoir with one disease-specific- and one general (SF-36) quality of life-questionnaire, rectoscopy with biopsies, and stool samples to evaluate inflammation, dysplasia, presence of Helicobacter pylori and calprotectin level. Results. Fourteen J-reservoirs were removed or deactivated, leaving 111 patients for followup. The followup time was 6.8 (1-15) years. 87.4% of the patients were satisfied. 93.1% had some kind of functional restriction: food- (75.5%), social- (28.9%), physical- (37%) or sexual restriction (15.3%). 18.6% had often or sometimes faecal incontinence. Low daytime faecal frequency was associated with good quality of life. 13 patients (12.6%) had a less favourable result. There was no pouch-dysplasia. Calprotectin levels were increased in patients with visible pouch inflammation or history of pouchitis. HP was diagnosed by RUT in 42.3%, but was not associated with inflammation or pouchitis. Conclusions. Most patients were satisfied with the J-reservoir in spite of a high frequency of various restrictions. 12.6% (13 patients) had a less favourable functional result, partly due to a high frequency of defecations, pain, pouchitis and inflammation.

Figure 1

SF-36 scores of 101 patients with J-reservoirs comparing patients who often or sometimes regretted the reservoir operation (n = 13) with patients who seldom or never (n = 88) regretted the reservoir operation. Higher scores indicate better function. Values for the general Norwegian population matched on age and gender are also shown. Subscale scores in the Short-Form Health Survey questionnaire (SF-36). Higher scores indicate better function. PF = physical function sum score, RP = role limitations/physical sum score, BP = bodily pain sum score, GH = general health sum score, VT = vitality sum score, SF = social function sum score, RE = role limitation/emotional problems, MH = mental health sum score. Significances are calculated with Student's t-test between functional and failed reservoirs: * = P < 0.05,  ** = P < 0.01, *** = P < 0.001.