Original Contribution
The American Journal of Gastroenterology (2005) 100, 2248–2253; doi:10.1111/j.1572-0241.2005.50617.x
The Impact of the Fecal Stream and Stasis on Immunologic Reactions in Ileal Pouch After Restorative Proctocolectomy for Ulcerative Colitis: A Prospective, Pilot Study
Takayuki Yamamoto MD1, Satoru Umegae MD1, Tatsushi Kitagawa MD1 and Koichi Matsumoto MD1
1Inflammatory Bowel Disease Center & Department of Surgery, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan
Correspondence: Takayuki Yamamoto, MD, Inflammatory Bowel Disease Center, Yokkaichi Social Insurance Hospital, 10-8 Hazuyamacho, Yokkaichi, Mie 510-0016, Japan
Received 21 April 2005; Revised 0000; Accepted 10 May 2005.
Abstract
OBJECTIVE:
The etiology of pouch inflammation after restorative proctocolectomy is unknown. The fecal stream and immunological reactions are potential pathological factors. This study was performed to examine the impact of the fecal stream and stasis on immunological reactions in the pouch.
METHODS:
Patients who underwent a restorative proctocolectomy with a covering ileostomy for ulcerative colitis were studied. Mucosal biopsy specimens were obtained from both the pouch and the proximal ileum at the time of ileostomy closure, and 3, 6, and 12 months after ileostomy closure. As a control group, normal ileal biopsies were obtained from patients with colonic polyps.
RESULTS:
At the time of ileostomy closure, mucosal interleukin-1
, interleukin-6, interleukin-8, and tumor necrosis factor-
levels in the pouch and the proximal ileum were not significantly different from those in the normal control group. At 3 months after ileostomy closure, the mucosal cytokine levels in the pouch increased significantly compared with those at ileostomy closure, and their levels were significantly higher than those in the proximal ileum. At 6 and 12 months after ileostomy closure, the mucosal cytokine levels in the pouch did not change significantly compared with those at 3 months after ileostomy closure. The mucosal cytokine levels in the proximal ileum did not change significantly during the entire study.
CONCLUSIONS:
The immunological reactions in the pouch occurred soon after ileostomy closure, and continued for at least 1 yr. The fecal stream and stasis play an important part in the pathogenesis of immunological reactions in the ileal pouch.
