CHRONIC POUCHITIS AFTER ILEAL POUCH-ANAL ANASTOMOSIS - RESPONSES TO BUTYRATE AND GLUTAMINE SUPPOSITORIES IN A PILOT-STUDY

Nonspecific, idiopathic inflammation of ileal pouch mucosa (''pouchiti s'') after ileal pouch-anal anastomosis is a common complication of th is surgical approach. The epithelium of the pouch is ileal, but variab le degrees of colonic metaplasia are natural sequelae of construction of such a pouch. One hypothesis is that pouchitis is caused by a defic iency of epithelial nutrition. Thus, a lack of butyric acid (the princ ipal metabolic fuel of colonocytes) or of glutamine (the main fuel of enterocytes) may develop. In this study, our aims were to determine th e concentration of total short-chain fatty acids in random stool sampl es obtained from patients with an ileal pouch-anal anastomosis with an d without pouchitis and to test the therapeutic effects of butyrate an d glutamine suppositories on pouchitis. During the study, all conventi onal therapy for pouchitis was discontinued. For 21 days, 9 patients p articipated in a butyrate trial, and 10 patients were treated with glu tamine. Total concentrations of fecal short-chain fatty acids were sig nificantly less in patients with pouchitis than in those without pouch itis. During treatment, 6 of the 10 patients who received glutamine ha d no recurrence of symptoms, but only 3 of the 9 patients who received butyrate responded similarly. Hence, further studies of glutamine in the treatment of pouchitis seem warranted.