Absorption and motility of the bypassed human ileum

Abstract

The authors assessed absorption and motility of the human ileum after a prolonged period of disuse. In eight patients with ulcerative colitis, a manometric-catheter assembly was placed via the ileostomy into the unused portion of distal ileum two months after ileal pouch-anal anastomosis and temporary diverting loop ileostomy. The distal ileum was perfused at 5 ml/min with an isosmotic solution of either sodium chloride or ileal chyme diluted with sodium chloride for three hours before and three hours after a meal on two consecutive days. Absorption was measured, single and clustered pressure waves were identified and quantitated with the aid of a computer program, and a motility index was calculated. Mean absorption +/- S.E.M. of both perfusates was poor on day 1 (-10 +/- 2 ml/25 cm x 30 min), and the meal induced no ileal motor response. By day 2, however, absorption of both perfusates was much improved (-1 +/- 2 ml/25 cm x 30 min; P less than 0.05), and the number of discrete clustered contractions and the motility index now clearly increased after the meal (2.6 +/- 0.6 vs. 7.2 +/- 1.0 clustered waves/hr; 7.5 +/- 0.5 vs. 9.7 +/- 0.2 motility units/30 min; P less than 0.05). The conclusion was that absorption and motility of the human ileum were impaired after two months of disuse, but that ileal absorption and motility improved one day after the introduction of isosmotic ileal perfusates.

The effect of faecal diversion on human ileum

“…A reduction in absorptive function and motility of the bypassed limb has been demonstrated in patients with a diversion ileostomy. 17 Motility may take up to 6 months to return to normal after closure of the ileostomy. 18 Attempts to improve the absorptive function of the distal limb before ileostomy closure have met with limited success.…”

Manometry of the Human Ileum and Ileocaecal Junction in Health, Disease and Surgery: A Systematic Review

“…Three studies defined the motility index as "log e (sum of amplitudes × number of contractions +1)" (30,39,40), one study described it as "log 10 (sum of amplitudes × number of peaks +1)" (32), four studies used the integration of the area under the pressure tracings (31,34,48,49) and one defined it as "[sum of log(amplitudes of contractions)]/number of contractions" (36).…”

“…Ten studies investigated ileal motility through either a loop or end ileostomy (4, 16, 20, 23, 24, 39-41, 44, 47). Five studies assessed the terminal ileum adjacent to an ileal pouch formed after proctocolectomy (17,29,39,43,50). Two studies featured patients who had colonic exclusion for management of hepatic encephalopathy (3,19) with one of these studies also featuring a patient with double-barrelled ascending colostomy for management of a pancreatic fistula (3).…”

“…Three studies utilized manometry in only the afferent limb of a loop ileostomy (20,23,24), four studies only investigated the efferent limb (16,(39)(40)(41) and one research team measured motility in both limbs (4). No direct comparisons between motility of the afferent and efferent limbs were made.…”

Renal Expression of the Essential Genes Associated with Sodium Transport Following a Total Proctocolectomy in Rats

“…Previous studies on the postoperative complications after total proctocolectomies demonstrate electrolyte alterations, bile-acid metabolic changes, nephrolithiasis, and pathologic bacterial colonization. [2][3][4][5] However, one of the frequent complications following a total proctocolectomy is dehydration associated with watery diarrhea. Dehydration with electrolyte imbalance sometimes develops in these patients when they have infectious enteritis and these symptoms are exacerbated by a pre-existing chronic deficit in the body fluid and sodium levels.…”