Absorption Studies after Ileal J-Pouch Anastomosis for Ulcerative Colitis: A Prospective Study

Abstract

Absorption studies were performed in 17 patients with ulcerative colitis operated on with colectomy and an ileal two-limbed J-pouch anastomosis. The patients were studied 3 and greater than or equal to 18 months after closure of the temporary ileostomy. Increased stool mass (median, 609 g/24 h) was found in all patients and was unchanged with time. Moderate steatorrhoea was present in 29% of the patients 3 months postoperatively, but faecal fat excretion normalized with time. Calcium absorption was normal in all but one patient regardless of time after operation. An abnormal bacterial deconjugation, evaluated by a 14C-glycocholic acid breath test was present in 27% of the patients and increased significantly with time. Forty per cent of the patients had increased faecal bile acid excretion. B12 malabsorption was present in 29-35% of the patients. In conclusion, ileal J-pouch anastomosis for ulcerative colitis causes increased stool mass in all patients and produces moderate bile acid deconjugation and malabsorption in about one-third to half. Substitution therapy with vitamin B12 is necessary in about one-third of the patients. Intestinal adaptation as far as absorption is concerned is minimal after the first 3 postoperative months.

Increased Mitogen-Activated Protein Kinase Activities Stimulated with Interleukin-1-Beta and Mechanism(s) of the Kinase Signaling Pathways in Rat Gastric Epithelial Cells

“…These findings may be related to disturbances in mucosal repair. The increased production of cytokines such as IL-1β and TNF-α in the H. pylori -infected gastric tissues thereby causing a disturbance in mucosal repair may support the present finding [3, 35]. However, to elucidate which of the MAP kinases is activated by stimulation of H. pylori , another experiment is needed next.…”

Clinical and Physiological Aspects of Ileal Pouch-Anal Anastomosis

“…Nevertheless, clinical signs of malnutrition or malabsorption are rare in these patients (77). Low vitamin B12 levels and decreased Schilling tests have been found in patients with ileal pouch-anal anastomosis (57,74,82).…”

“…Hylander et al (82) found moderate steatorrhea in approxi mately 30% of patients 3 months after ileostomy closure, but fecal fat excretion normalized with time. The absorption of carbohydrates, amino acids, and bile acids by the ileal pouch mucosa after proctocolectomy with ileal pouch-anal anasto mosis has been found to be markedly decreased compared to normal ileum (83).…”

Impact of Surgery on the Development of Duodenal Cancer in Patients with Familial Adenomatous Polyposis

“…Earlier studies show that the ileoanal anastomosis may disturb bile acids absorption. 19,20 Patients with IAA show a reduced biliary secretion of bile acids and reduced masses of cholesterol, bile acid, phospholipids. [21][22][23] In particular the deoxycholic acid is significantly reduced in patients with IAA.…”