Functional assessment of bacterial colonization in patients with ileal pouch-anal anastomosis and Brooke ileostomy.
OBJECTIVE
This study was designed to determine whether patients with an ileal pouch-anal anastomosis have increased gastrointestinal bacterial colonization as assessed functionally compared with patients with Brooke ileostomy and to determine the effect of pouch bacterial colonization on pouch function.


METHODS
Gastrointestinal bacterial colonization in 27 patients with an ileal pouch-anal anastomosis and 20 patients with a Brooke ileostomy was assessed using the 14C-glycocholate and glucose-hydrogen breath tests. Bacterial colonization was correlated with pouch function and pouch satisfaction.


RESULTS
Patients with ileal pouch-anal anastomosis had increased levels of gastrointestinal bacterial colonization as measured using the 14C-glycocholate method compared with patients with Brooke ileostomy (P = 0.03). Only three patients had a positive result on the glucose hydrogen breath test, two patients with ileal pouch-anal anastomosis, and one with ileostomy; however, the ileal pouch-anal anastomosis patients did have higher levels on this test. Pouch satisfaction and pouch symptoms of urgency were not correlated with levels of bacterial colonization, whereas there was a nonsignificant trend with continence.


CONCLUSIONS
We showed increased levels of gastrointestinal bacterial colonization with ileal pouch-anal anastomosis compared with Brooke ileostomy. The increase in bacteria is not limited to the pouch but also are found in the proximal small bowel. There was no correlation between bacterial colonization and urgency, continence, and pouch satisfaction. Reasons for this are discussed.
Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
Steven
S
Kelly
James
J
Yeo
Greg M
GM
Robertson
Bruce
B
Chapman
J Elisabeth
JE
Wells
Frank A
FA
Frizelle
D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D001419:Bacteria / Q000254:growth & development*; D001944:Breath Tests; D002250:Carbon Radioisotopes; D002756:Cholagogues and Choleretics; D039021:Colonic Pouches / Q000382:microbiology*; D004064:Digestive System / Q000382:microbiology*; D005242:Fecal Incontinence; D006000:Glycocholic Acid; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D007081:Ileostomy; D011446:Prospective Studies
D002250:Carbon Radioisotopes; D002756:Cholagogues and Choleretics; D006859:Hydrogen; D006000:Glycocholic Acid