EXERCISE CAPACITY IN PATIENTS UNDERGOING PROCTOCOLECTOMY AND SMALL-BOWEL RESECTION FOR CROHNS-DISEASE

The effect of proctocolectomy and small bowel resection on working cap acity has not been assessed objectively in previous research. Twenty-n ine patients with Crohn's disease were investigated with cycle ergomet ry and a questionnaire, following proctocolectomy with and without sma ll bowel resection. Maximal exercise load is known to correspond well with working capacity, particularly when account is taken of body comp osition and metabolic variables. Maximal exercise load was reduced mar ginally (by 9 per cent) in patients without small bowel resection and by 22 per cent in patients with moderate small bowel resection (15-30 per cent resection). Patients with extensive bowel resection (more tha n 50 per cent) had a 40 per cent reduction in the maximal exercise loa d. This reduction in maximal exercise load was greater than predicted when accounting for reduction in muscle mass. All patients had a norma l oxygen uptake including resting energy expenditure. Urinary sodium a nd magnesium excretion was low in the group with moderate bowel resect ion, whereas the extensively resected patients were malnourished and h ad a reduced body cell mass. The authors conclude that the working cap acity was of secondary to malabsorption. However, the patients seemed unaware of the degree of their diminished working capacity. This reduc ed capacity makes it unlikely that they would be able to perform any l abour involving high energy consumption at the level of 500-700 W, and this inability was reflected by a high rate of unemployment among the patients.