The impact of the fecal stream and stasis on immunologic reactions in ileal pouch after restorative proctocolectomy for ulcerative colitis: a prospective, pilot study.
OBJECTIVE
The etiology of pouch inflammation after restorative proctocolectomy is unknown. The fecal stream and immunological reactions are potential pathological factors. This study was performed to examine the impact of the fecal stream and stasis on immunological reactions in the pouch.


METHODS
Patients who underwent a restorative proctocolectomy with a covering ileostomy for ulcerative colitis were studied. Mucosal biopsy specimens were obtained from both the pouch and the proximal ileum at the time of ileostomy closure, and 3, 6, and 12 months after ileostomy closure. As a control group, normal ileal biopsies were obtained from patients with colonic polyps.


RESULTS
At the time of ileostomy closure, mucosal interleukin-1beta, interleukin-6, interleukin-8, and tumor necrosis factor-alpha levels in the pouch and the proximal ileum were not significantly different from those in the normal control group. At 3 months after ileostomy closure, the mucosal cytokine levels in the pouch increased significantly compared with those at ileostomy closure, and their levels were significantly higher than those in the proximal ileum. At 6 and 12 months after ileostomy closure, the mucosal cytokine levels in the pouch did not change significantly compared with those at 3 months after ileostomy closure. The mucosal cytokine levels in the proximal ileum did not change significantly during the entire study.


CONCLUSIONS
The immunological reactions in the pouch occurred soon after ileostomy closure, and continued for at least 1 yr. The fecal stream and stasis play an important part in the pathogenesis of immunological reactions in the ileal pouch.
Yamamoto
Takayuki
T
Inflammatory Bowel Disease Center & Department of Surgery, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan.
Umegae
Satoru
S
Kitagawa
Tatsushi
T
Matsumoto
Koichi
K
D000328:Adult; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000378:metabolism* / Q000601:surgery; D039021:Colonic Pouches; D016207:Cytokines / Q000378:metabolism*; D003672:Defecation; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000378:metabolism*; D007413:Intestinal Mucosa / Q000378:metabolism*; D008297:Male; D010865:Pilot Projects; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors
D016207:Cytokines