Abstracts
2000 Digestive Disease Week

# 2399 Ileoanal Pouch Function Is Related to Postprandial Pouch Tone.
J. Steens, W.A. Bemelman, W.J.H.J. Meijerink, G. Griffioen, R.A. Hogezand, C.B.H.W. Lamers, A.A.M. Masclee, Amsterdam, Netherlands, Leiden, Netherlands¡

Functional impairments are frequently observed in patients with an ileal pouch-anal anastomosis. It has recently been shown that meal ingestion increases pouch tone and motility. Little is known however on the influence of meal stimulated pouch characteristics on pouch function. Aim of this study was to characterize basal and postprandial pouch motor and sensory characteristics in relation to clinical pouch function in patients with an ileoanal pouch using an electronic barostat. Nineteen patients with an ileoanal J-pouch after proctocolectomy for ulcerative colitis were studied after a postoperative follow-up period of 2.1 ± 0.6 yr. None of the patients had fecal incontinence. The groups were divided into those with high stool frequency (>6 per 24 hr, n=8 patients) or an adequate stool frequency (£6 per 24 hr, n=11 patients). All patients underwent a pressure distension procedure of the pouch, from which pouch compliance and sensitivity characteristics were calculated. A barostat procedure at operating pressure was performed to assess the influence of a meal on pouch tone and motility. Results: Compliance was not significantly different between the two groups (10±2 vs. 11±1 ml/mmHg), nor were sensitivity characteristics of urge and pain. However, after meal ingestion the pouch volume decreased by 70±10% in the group with poor pouch function compared to 29±9% in the group with adequate pouch function (p<0.01). The postprandial reduction of pouch volume correlated significantly with the daytime stool frequency (r = 0.53, p<0.05), but not with stool volume. Frequency and amplitude of phasic pouch contractions increased significantly postprandially, but no differences in motility characteristics were observed between both patient groups. Conclusions: In patients with uniform pouch design and follow-up after pouch construction: 1) pouch compliance and sensitivity are not different between patients with normal and high stool frequency, 2) but postprandial pouch tone is significantly increased in patients with high stool frequency. Thus, meal stimulation is essential to detect alterations in pouch function.