Serum biochemical evaluation of patients with functional pouches ten to 20 years after restorative proctocolectomy.
BACKGROUND
Restorative proctocolectomy with an ileal pouch-anal anastomosis is a surgical treatment of choice for ulcerative colitis and familial adenomatous polyposis (FAP). Pouchitis is a significant enigmatic morbidity. In the long-term, these patients, we anticipated, would experience biochemical profiling alterations after years of retaining functionally acceptable pouches. This pilot study was aimed at assessing results of essential biochemical variables more than 10 years after surgery.


METHODS
The investigation was carried out in 91 patients; 39 were women. Eight-eight had ulcerative colitis, while three had FAPs. The hand-sewn ileal reservoirs after mucoso-proctocolectomy were 66 S and 25 J. The analyses were compared short-term vs long-term. Patients were investigated and were their own control.


RESULTS
Long-term, incidence of acute and chronic pouchitis was 2 and 13%. Eleven and 4% of patients had hypomagnesaemia and hypocalcaemia. Mean levels were significantly enhanced (p<0.01 and p<0.0002). Hypomagnesaemia corresponded to episodes of pouchitis and was corrected with oral magnesium and antibiotics. Hypoferric anaemia was diagnosed in 7% and treated with oral iron tablets. Chronic pouchitis and recurrent pouch mucosa bleeding were the cause. Hypohemoglobinemia and hypocyanocobalaminemia were noted in 5% and 5%, respectively. Erythrocyte sedimentation rate and white blood cells were supra-normal in 13 and 10%, which corresponded with pouchitis. A significant (p<0.03) steady rise of mean serum immunoglobulin G without correlation to pouchitis was noted.


CONCLUSIONS
Long-term functional results did not deteriorate. Pouchitis was a significant enigmatic morbidity. Severe or chronic pouchitis complicated hypoferric and vitamin B(12) anemia and hypomagnesaemia.
M'Koma
Amosy Ephreim
AE
Center for Surgical Sciences, Department of Surgery, Karolinska University Hospital, SE-141 86 Huddinge, Stockholm, Sweden. amosy.mkoma@vanderbilt.edu
D001798:Blood Proteins / Q000032:analysis*; D039021:Colonic Pouches; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006405:Hematology; D006801:Humans; D008055:Lipids / Q000097:blood*; D008099:Liver / Q000201:enzymology; D008297:Male; D016737:Proctocolectomy, Restorative / Q000379:methods*
D001798:Blood Proteins; D004573:Electrolytes; D008055:Lipids