Chronic pouchitis is not related to small intestine bacterial overgrowth.
BACKGROUND
Restorative ileal pouch-anal anastomosis (IPAA) potentially may lead to upper gastrointestinal tract motility disturbances. In addition, a bacterial etiology of IPAA complication-pouchitis-has been suggested. The oro-anal transit time is significantly reduced in this patient group. Therefore, we investigated the hypothesis if IPAA constitutes a significant risk for small intestine bacterial overgrowth (SIBO).


METHODS
Twenty-eight patients age 23-71 years with IPAA operated due to ulcerative colitis without subjective symptoms of pouchitis were evaluated as outpatients according to the prescheduled follow-up after operation and included in the study. The modified Pouchitis Disease Activity Index (PDAI) was determined in all IPAA patients, including clinical, endoscopic, and histopathological (Moskowitz criteria) parameters. In addition, anorectal manometry was performed. The presence of SIBO was determined with the use of a glucose breath test (GBT).


RESULTS
In 1 subject (3.6%) an abnormal GBT result was recorded consistent with SIBO. In addition, 2 borderline values (7.1%) were documented. Both patients with SIBO as subjects with borderline values presented with low PDAI values. All patients with PDAI >7 had normal GBT results. In patients with SIBO the maximal tolerated rectal volume was significantly higher than in subjects without SIBO (P < 0.007). Similarly, the PDAI value was significantly lower (P < 0.014).


CONCLUSIONS
Asymptomatic chronic pouchitis is not related to SIBO. However, excessive colonization of the small intestine does occur in some IPAA patients and needs to be kept in the differential diagnosis.
Lisowska
Aleksandra
A
I Chair of Pediatrics, Department of Gastroenterology and Metabolism, Poznañ University of Medical Sciences, Poznañ, Poland.
Banasiewicz
Tomasz
T
Marciniak
Ryszard
R
Drews
Michal
M
Majewski
Przemyslaw
P
Herzig
Karl-Heinz
KH
Walkowiak
Jaroslaw
J
D000328:Adult; D000368:Aged; D001765:Blind Loop Syndrome / Q000382:microbiology*; D001944:Breath Tests; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000382:microbiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*