FECAL BILE-ACIDS, SHORT-CHAIN FATTY-ACIDS, AND BACTERIA AFTER ILEAL POUCH-ANAL ANASTOMOSIS DO NOT DIFFER IN PATIENTS WITH POUCHITIS

Construction of an ileal reservoir changes the fecal bacterial flora a nd the fecal composition of bile acids and short-chain fatty acids. We examined the relationships between pouch inflammation (pouchitis) and pouch content, as assessed by analysis of fecal bacteria, bile acids, and short chain fatty acids. Four groups were studied: ileal pouch-an al anastomosis (IPAA) for ulcerative colitis with pouchitis (N = 10), IPAA without pouchitis (N = 5), IPAA for familial adenomatous polyposi s without pouchitis (N = 5); and Brooke ileostomy for ulcerative colit is, which served as controls (N = 5). Pouchitis was defined as greater than or equal to 7 points on an 18-point pouchitis disease activity i ndex. Aerobic and anaerobic bacteria were quantitatively cultured. Tot al aqueous-phase bile acids were measured by thin-layer chromatography and an enzymatic 3 alpha-OH hydroxysteroid dehydrogenase method. Feca l short chain fatty acids were measured by gas liquid chromatography. AH patients with an IPAA had higher ratios of anaerobes/aerobes and co ncentrations of anaerobic gram-negative rods than did patients with an ileostomy. There were no other differences between patient groups wit h respect to bacteria, aqueous-phase total bile acids, or fecal short- chain fatty acids. Fecal concentrations of bacteria, bile acids, and s hort-chain fatty acids were similar in patients with and without pouch itis, indicating that these factors can not be the sole cause of pouch itis.