FECAL DIVERSION FOR CROHNS COLITIS - A MODEL TO STUDY THE ROLE OF THEFECAL STREAM IN THE INFLAMMATORY PROCESS

The high incidence of clinical remission after faecal diversion for Cr ohn's colitis suggests the faecal stream may play a part in the inflam matory mechanism. The effect of faecal diversion (n=22) and restoratio n of intestinal continuity (n=10) was assessed in patients with Crohn' s colitis and compared with controls. Faecal diversion produced signif icant improvement in the disease activity index mean (SEM) (before 176 (9); after 114 (9), p<0.01) and serum albumin concentrations (before 33 (3.0); after 38 (3.0), p<0.05) in all patients with Crohn's colitis . The crypt cell production rate (CCPR) was maintained after faecal di version for Crohn's colitis but fell in the control group (before=3.6 (0.8)), at two (1.4 (0.4), p<0.02), and six weeks (1.6 (0.4), p<0.05). Mucosal glucosamine synthetase activity, reflecting glycoprotein synt hesis, was significantly lower in patients with Crohn's colitis (analy sis of variance p<0.05) after diversion but was maintained in the cont rol group. Restoration of intestinal continuity failed to produce reci procal changes. The sustained cellular proliferation and fall in glyco protein synthesis in Crohn's colitis after faecal diversion may repres ent the end of an exaggerated protective response and regenerative hyp erplasia after exclusion of the faecal stream. This study suggests the faecal stream may participate in the inflammatory process in Crohn's colitis. The underlying mechanism is unknown.