Bowel Function After J-Pouch May Be More Complex Than Previously Appreciated: A Comprehensive Analysis to Highlight Existing Knowledge Gaps

Abstract

Background: Functional outcomes following J-pouch for ulcerative colitis have been studied, but lack standardization in which symptoms are reported. Furthermore, the selection of symptoms studied has not been patient-centered.Objective: Utilize a validated bowel function survey to determine which symptoms are present after J-pouch, and whether patients display a functional profile similar to Low Anterior Resection Syndrome. Design: Retrospective analysis of a prospectively maintained single center database Settings: Colorectal surgery center of a tertiary care academic hospital Patients: 159 J-pouch patients, ≥6 months after ileostomy reversal Main Outcome Measures: Memorial Sloan Kettering Cancer Center Bowel Function Instrument; original Bowel Function Instrument validation cohort used as historical comparison (n=127) Results:The mean total Bowel Function Instrument score for the J-pouch cohort was 59.9+/−9.7 compared to a reported average score of 63.7+/−11.6 for low anterior resection patients in the validation cohort (p<0.001), indicating worse bowel function in J-pouch patients. When evaluating the Bowel Function Instrument subscales, J-pouch patients reported frequency subscale scores of 18.2+/−3.8, diet scores of 12.2+/−3.8, and urgency scores of 15.9+/−3.7, compared to 21.7+/−4.5

Determinants of long‐term function and general well‐being in patients with an ileoanal pouch

“…Coordination of evacuation may be compromised in some patients before surgery. Evacuation problems have been reported in up to 56% 3 of patients with an ileoanal pouch and have been shown to increase with time 26 . Brandsborg et al 15 .…”

“…2 Fecal incontinence and evacuation difficulty are common after pouch surgery. 2,3 It is unknown whether the development of these symptoms can be predicted before surgery. If so, it could lead to a preoperative behavioral intervention for bowel dysfunction.…”

“…6 Difficult or incomplete defecation affects up to 26% of patients with IBD in disease remission 7 and up to 56% of patients with an ileoanal pouch. 3 In the absence of active inflammation or mechanical obstruction from strictures, these symptoms can be improved with medical and behavioral treatments. 8,9 Postoperative pouch function may also be affected by psychological factors.…”

“…Health‐related quality of life and patient satisfaction are high when pouch function is good, but poor pouch function negatively impacts physical, psychosocial, and sexual functioning and productivity 2 . Fecal incontinence and evacuation difficulty are common after pouch surgery 2,3 . It is unknown whether the development of these symptoms can be predicted before surgery.…”

“…Fecal urgency and fear of incontinence also cause significant distress, shame, embarrassment, and isolation 6 . Difficult or incomplete defecation affects up to 26% of patients with IBD in disease remission 7 and up to 56% of patients with an ileoanal pouch 3 . In the absence of active inflammation or mechanical obstruction from strictures, these symptoms can be improved with medical and behavioral treatments 8,9 …”