ACUTE POUCHITIS AND DEFICIENCIES OF FUEL

PURPOSE: Acute pouchitis is a troublesome complication after restorati ve proctocolectomy. Deficiency of fuel, especially short chain fatty a cids (SCFA), produced by anaerobic bacterial fermentation of saccharid es, is implicated in ulcerative and diversion colitis. Our hypothesis was that SCFA deficiency occurs in acute pouchitis, and correction of the deficiency is associated with resolution of pouchitis. METHODS: Th irty-two patients were studied, 10 with histologically confirmed acute pouchitis and 22 with healthy pouches. Stool concentrations of SCFA ( acetic, propionic, butyric, and valeric acids) were determined by gas- liquid chromatography. Quantitative bacteriologic studies of stool wer e carried out, and four-quadrant pouch biopsies were assessed by a pat hologist who was unaware of the clinical state. Patients with pouchiti s were treated for six weeks with metronidazole and given dietary advi ce to increase their intake of fermentable saccharides. RESULTS: Stool concentrations of SCFA were significantly less in pouchitis patients compared with patients with healthy pouches (340 mu mol/g(range, 124-4 99) vs. 93 (range, 44-136)P < 0.01). No differences in anaerobic or ae robic counts were seen. Resolution of pouchitis was associated with a significant increase in SCFA, but anaerobic counts fell. CONCLUSION: D eficiency of SCFA is implicated in acute pouchitis.