# 2321 Stasis Is Associated with Ileal J-Pouch Inflammation and Oxidative
Stress in a Rat Model of Ileal Pouch-Anal Anastomosis (IPAA).
Khaled O Shebani, Arthur F. Stucchi, James P. McClung, Eve R. Beer,
Wayne W. Lamorte, James M. Becker, Boston, MA
Introduction: Colectomy with IPAA is the operation of choice for patients
with chronic ulcerative colitis, but pouchitis remains a major late complication.
Fecal stasis has been implicated in the etiology of pouchitis; however,
the mechanism is unclear, in part, due to the lack of a reproducible
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: 22 Sprague-Dawley rats underwent total colectomy with either
straight (st)ileorectal or ileal J pouch-rectal anastomosis and 6 non-operated
(non-op) controls. 30 days post-op, animals were randomized into 2
groups: no dextran sulfate sodium (DSS) or 5% DSS in the water for 4 days.
Urinary 8-isoprostane (8-IP)levels were measured as a marker of oxidative
stress and mucosal neutrophil infiltration was assessed by histology and
myeloperoxidase activity (MPO).
Results: Survival was = 95% and weight gain after 12 days matched controls.
Serial barium radiographs over 48 hr showed stasis in the J-pouches,
and charcoal transit time was 3x longer (pŁ0.05)than that in straight
ileorectal rats. MPO was significantly elevated in J-pouch rats and this was
exacerbated by DSS which produced increased 8-IP levels (pŁ 0.05),pouch
ulcerations, diarrhea and rectal bleeding (Table).
Conclusions: 1) Construction of an ileal J-pouch following colectomy is
technically feasible in a rat; 2) Stasis in the J-pouch is associated with elevations
in MPO and 8-IP, providing evidence of neutrophil infiltration
and oxidative stress; 3) DSS augments stasis-induced ulceration and produces
pathological findings similar to pouchitis suggesting this may be a
viable model to study the pathogenesis of pouchitis.
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