PECTIN AND METHYL CELLULOSE DO NOT AFFECT INTESTINAL FUNCTION IN PATIENTS AFTER ILEAL POUCH-ANAL ANASTOMOSIS

Objectives: Although ileal pouch-anal anastomosis is the procedure of choice for most patients with ulcerative colitis or familial adenomato us polyposis, most patients have problems with stool frequency and/or consistency. Although most clinicians recommend fiber supplementation for these patients, we could find no studies that prove the efficacy o f this practice. The first purpose of this study was to document the e ffect of fiber supplementation on intestinal function in patients afte r heal pouch-anal anastomosis. Because pectin, a soluble fiber supplem ent, has been reported to slow gastric and intestinal transit, we also hypothesized that pectin would be a superior fiber supplement in thes e patients. The second purpose, therefore, was to determine whether th e effects of pectin on intestinal transit would result in decreased st ool frequency in patients with an ileal pouch. Methods: Thirteen patie nts who had undergone heal pouch-anal anastomosis for ulcerative colit is were entered into a 9-wk crossover study. The protocol consisted of three 2-wk study periods, each of which was preceded by a 1-wk washou t period. During the three study periods patients supplemented their d iets, in random order, with Citrucel, 1 tablespoon twice daily; pectin , 1 tablespoon twice daily; or no supplement. Patients maintained deta iled dietary and bowel function diaries. Results: The effects (mean +/ - SE) of Citrucel and pectin supplementation are summarized in Table 1 . There was no significant effect of either supplement on stool freque ncy, pouch function, bloating, or stool consistency. In addition, ther e were no differences in continence. Conclusions: We found no evidence to support the common practice of fiber supplementation in patients w ith an heal pouch. Furthermore, this study did not find that stool fre quency decreased during supplementation with pectin. We conclude that there is little role for fiber supplementation in patients with an hea l pouch.