anastomosis: relation with functional outcome and inflammation

Restorative proctocolectomy with pelvic ileal reservoir is a weli accepted option for the surgical treatment of ulcerative colitis. Acute pouchitis is a common complication and resembles acute ulcerative colitis. Patients with ulcerative colitis carry Escherichia coli that adhere to epithelial cells and thus this study examined whether acute pouchitis is associated with the carriage of adhesive E coli. E coli isolated from stool samples from 24 patients (median age 34 years, range 16-64; 13 men, 11 women) who had had restorative proctocolectomy with pelvic ileal reservoir were examined by means of the buccal epithelial cell adhesion assay. Patients were studied at a median of 12 months (range 7-21) after operation. Eight of 24 patients had acute pouchitis at the time of study. Adhesive E coli were detected in nine of 24 patients with a pelvic ileal reservoir compared with none of 12 controls (p<005). The buccal epithelial cell adhesion index was inversely related to the degree of acute pouchitis (rr= -0 46, p=0024) and to the functional outcome (r,=-0*49, p=0.022). Carriage of adhesive E coli was not related to the design of the reservoir. By contrast with ulcerative colitis, acute pouchitis is not associated with the carriage of adhesive E coli. (Gut 1993; 34: 1379-1383) Gastroenterology Unit, A J Lobo J Rothwell AT R Axon Academic Unit of Surgery, P M Sagar Academic Unit of Pathology, P Quirke and University Department of Microbiology, The General Infirmary at Leeds, Leeds P Godwin Correspondence to: Department of Gastroenterology, Frenchay Hospital, Frenchay Park Road, Bristol, BS16 ILE. Accepted for publication 18 February 1993 Restorative proctocolectomy with a pelvic ileal reservoir or 'pouch' has become a widely accepted operation for patients with ulcerative colitis and familial adenomatous polyposis.l The development of acute inflammation in the mucosa of the pouch, pouchitis, is one of the main longterm complications of restorative proctocolectomy. The reported incidence of pouchitis varies from 7 to 45 per cent.2 The symptoms associated with pouchitis share a number of similarities with those of ulcerative colitis. The condition is characterised by increased frequency of bowel actions with the passage of blood and poorly formed stool and lower abdominal cramp like pains.3 The condition typically runs a relapsing and remitting