title: Stasis predisposes ileal pouch inflammation in a rat model of ileal pouch-anal anastomosis.
abstract: BACKGROUND
  While restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the definitive surgical treatment for patients suffering from chronic ulcerative colitis (CUC), pouchitis still remains a major late complication. Fecal stasis has been implicated in the etiology of ileal inflammation; however, the mechanism(s) remain unclear, in part due to the lack of an animal model. Our goal was to surgically mimic the IPAA procedure in a rat to investigate the hypothesis that stasis leads to biochemical changes that predispose the ileal pouch to inflammation.
  
  
  METHODS
  Thirty-two Sprague-Dawley rats underwent total colectomy with either straight ileorectal (IRA) or IPAA, and 11 nonoperated rats served as controls (Controls). Twenty-one d postoperatively, 48 h serial barium radiographs and 12 h charcoal transit follow-through studies were performed. Following sacrifice, ileal tissue was harvested for the measurement of myeloperoxidase activity (MPO) activity, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) mRNA levels, and histology.
  
  
  RESULTS
  Serial barium radiographs showed stasis in the ileal pouch compared with IRA animals, and charcoal transit times that were two times longer (P ≤ 0.05) than that in the straight IRA rats. Ileal pouch MPO levels were significantly elevated in the IPAA rats compared with the straight IRA rats. ICAM-1 and VCAM-1 mRNA levels were not associated with neutrophil infiltration.
  
  
  CONCLUSIONS
  These studies showed that ileal pouch stasis predisposes biochemical and histological evidence of ileal pouch mucosal inflammation. Studies such as this may provide the rationale for novel, adjunct therapies for the management of pouchitis in patients having undergone IPAA for CUC.
authors.affiliation: Department of Surgery, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
authors.forename: Arthur F
authors.initials: AF
authors.lastname: Stucchi
authors.forename: Khaled O
authors.initials: KO
authors.lastname: Shebani
authors.forename: Karen L
authors.initials: KL
authors.lastname: Reed
authors.forename: Adam C
authors.initials: AC
authors.lastname: Gower
authors.forename: Michael F
authors.initials: MF
authors.lastname: Alapatt
authors.forename: Keith M
authors.initials: KM
authors.lastname: Crivello
authors.forename: James P
authors.initials: JP
authors.lastname: McClung
authors.forename: James M
authors.initials: JM
authors.lastname: Becker
mesh_terms: D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D000818:Animals; D001464:Barium; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000473:pathology / Q000502:physiology*; D003672:Defecation / Q000502:physiology; D004195:Disease Models, Animal; D005769:Gastrointestinal Motility / Q000502:physiology*; D007082:Ileum / Q000601:surgery; D018799:Intercellular Adhesion Molecule-1 / Q000235:genetics; D008297:Male; D008871:Microvilli / Q000473:pathology; D009195:Peroxidase / Q000378:metabolism; D019449:Pouchitis / Q000000981:diagnostic imaging / Q000276:immunology* / Q000503:physiopathology*; D012333:RNA, Messenger / Q000378:metabolism; D011859:Radiography; D051381:Rats; D017207:Rats, Sprague-Dawley
chemical_list: D012333:RNA, Messenger; D018799:Intercellular Adhesion Molecule-1; D001464:Barium; D009195:Peroxidase