Acute pouchitis and deficiencies of fuel.
OBJECTIVE
Acute pouchitis is a troublesome complication after restorative proctocolectomy. Deficiency of fuel, especially short chain fatty acids (SCFA), produced by anaerobic bacterial fermentation of saccharides, is implicated in ulcerative and diversion colitis. Our hypothesis was that SCFA deficiency occurs in acute pouchitis, and correction of the deficiency is associated with resolution of pouchitis.


METHODS
Thirty-two patients were studied, 10 with histologically confirmed acute pouchitis and 22 with healthy pouches. Stool concentrations of SCFA (acetic, propionic, butyric, and valeric acids) were determined by gas-liquid chromatography. Quantitative bacteriologic studies of stool were carried out, and four-quadrant pouch biopsies were assessed by a pathologist who was unaware of the clinical state. Patients with pouchitis were treated for six weeks with metronidazole and given dietary advice to increase their intake of fermentable saccharides.


RESULTS
Stool concentrations of SCFA were significantly less in pouchitis patients compared with patients with healthy pouches (340 mumol/g (range, 124-492) vs. 93 (range, 44-136) P < 0.01). No differences in anaerobic or aerobic counts were seen. Resolution of pouchitis was associated with a significant increase in SCFA, but anaerobic counts fell.


CONCLUSIONS
Deficiency of SCFA is implicated in acute pouchitis.
Sagar
P M
PM
Royal Liverpool University Hospital, United Kingdom.
Taylor
B A
BA
Godwin
P
P
Holdsworth
P J
PJ
Johnston
D
D
Lewis
W
W
Miller
A
A
Quirke
P
P
Williamson
M
M
D000085:Acetates / Q000032:analysis; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D002087:Butyrates / Q000032:analysis; D020148:Butyric Acid; D015169:Colony Count, Microbial; D005232:Fatty Acids, Volatile / Q000008:administration & dosage / Q000032:analysis*; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D006801:Humans; D007079:Ileitis / Q000209:etiology* / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010421:Pentanoic Acids / Q000032:analysis; D016737:Proctocolectomy, Restorative; D011422:Propionates / Q000032:analysis
D000085:Acetates; D002087:Butyrates; D005232:Fatty Acids, Volatile; D010421:Pentanoic Acids; D011422:Propionates; D020148:Butyric Acid; C038780:n-pentanoic acid; C029658:propionic acid