Motility of the small intestine after proctocolectomy and ileal pouch-anal anastomosis

Abstract

Though the mechanisms of continence after proctocolectomy and ileal pouch-anal anastomosis have been studied, functions of the small intestine have received little attention. However, frequent stools and urgency plague some patients who are otherwise quite continent. Motility of the jejunum and ileum was assessed in eight patients with ulcerative colitis who were studied 4 to 24 months after proctocolectomy and ileal pouch-anal anastomosis; these findings were compared to those in six healthy volunteers. Continuous manometric recordings from the small bowel were obtained in both groups for 16 to 23 hours of fasting; postprandial recordings were made for 6 hours following a mixed meal (800 kcal, 20% protein, 40% fat, 40% carbohydrate) in the ileoanal patients. The duration, velocity of propagation, and periodicity of the migrating motor complex did not differ between the groups (P greater than 0.05). Discrete bursts of clustered contractions were recorded from all of the controls and in five of eight patients. Likewise, we recorded from all controls and five of eight patients large amplitude, prolonged waves of pressure which propagated distally. However, in controls these large amplitude waves were confined to the terminal ileum, but in patients these were detected in the jejunoileum, up to 125 cm proximal to the ileal pouch. We conclude that jejunoileal motility is not greatly altered by proctocolectomy with ileal pouch-anal anastomosis. However, the appearance of the large amplitude, rapidly propagating waves in the proximal jejunoileum after operation may be a response to increased storage within and distention of the distal bowel.