ALTERATION IN INTESTINAL PERMEABILITY AFTER ILEAL POUCH-ANAL ANASTOMOSIS

The physiologic changes that occur when the small bowel is used as a r eservoir, as in the ileal pouch-anal anastomosis, are poorly understoo d. Alterations in bowel permeability, which may lead to bacterial tran slocation that could result in illness or dysfunction of the pouch, ma y be one such consequence of the pouch procedure. METHODS: Whole-bowel permeability was evaluated in patients with and without the pouch thr ough the use of an orally consumed nonmetabolizable sugar clearance te chnique. Patients in whom the ileal pouch-anal anastomosis was perform ed for ulcerative colitis (17 patients) and patients with familial pol yposis (7 patients) were compared with normal healthy volunteers (10 p atients) and patients with ulcerative colitis with and without curativ e colectomy and ileostomy (6 and 5 patients, respectively). RESULTS: M easured by this technique, no differences were noted in bowel permeabi lity between the volunteers and patients with ulcerative colitis, even after colectomy and ileostomy (1.7 +/- 0.4 in normal healthy voluntee rs, 1.8 +/- 0.5 in patients with ulcerative colitis without stoma, and 1.4 +/- 0.2 in patients with ulcerative colitis with ileostomy). The group of patients with an ileal reservoir, however, had a significantl y increased index of measured bowel permeability (3.5 +/- 0.5 in patie nts with ulcerative colitis and 5.1 +/- 0.7 in patients with familial polyposis; P < 0.05 by analysis of variance compared with normal healt hy volunteers and patients with ulcerative colitis with or without ile ostomy). CONCLUSION: The exact site, cause, and consequence of this po ssible alteration of bowel permeability are unclear but appear to be r elated to the presence of the pouch and are not caused by the underlyi ng pathologic diagnosis.