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Acute pouchitis and deficiencies of fuel

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Acute pouchitis is a troublesome complication after restorative proctocolectomy. Deficiency of fuel, especially short chain fatty acids (SCFA), produced by anaerobic bacterial fermentation of saccharides, is implicated in ulcerative and diversion colitis. Our hypothesis was that SCFA deficiency occurs in acute pouchitis, and correction of the deficiency is associated with resolution of pouchitis. METHODS: Thirty-two patients were studied, 10 with histologically confirmed acute pouchitis and 22 with healthy pouches. Stool concentrations of SCFA (acetic, propionic, butyric, and valeric acids) were determined by gas-liquid chromatography. Quantitative bacteriologic studies of stool were carried out, and four-quadrant pouch biopsies were assessed by a pathologist who was unaware of the clinical state. Patients with pouchitis were treated for six weeks with metronidazole and given dietary advice to increase their intake of fermentable saccharides. RESULTS: Stool concentrations of SCFA were significantly less in pouchitis patients compared with patients with healthy pouches (340 μ mol/g (range, 124–492) vs.93 (range, 44–136) P<0.01). No differences in anaerobic or aerobic counts were seen. Resolution of pouchitis was associated with a significant increase in SCFA, but anaerobic counts fell. CONCLUSION: Deficiency of SCFA is implicated in acute pouchitis

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Authors and Affiliations

  1. Royal Liverpool University Hospital, Liverpool, UK

    P. M. Sagar F.R.C.S., B. A. Taylor F.R.C.S., P. Godwin M.R.C.Path., P. J. Holdsworth F.R.C.S., D. Johnston F.R.C.S., W. Lewis F.R.C.S., A. Miller F.R.C.S., P. Quirke M.R.C.Path. & M. Williamson F.R.C.S.

  2. General Infirmary at Leeds, Leeds, UK

    P. M. Sagar F.R.C.S., B. A. Taylor F.R.C.S., P. Godwin M.R.C.Path., P. J. Holdsworth F.R.C.S., D. Johnston F.R.C.S., W. Lewis F.R.C.S., A. Miller F.R.C.S., P. Quirke M.R.C.Path. & M. Williamson F.R.C.S.

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  1. P. M. Sagar F.R.C.S.
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  2. B. A. Taylor F.R.C.S.
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  3. P. Godwin M.R.C.Path.
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  4. P. J. Holdsworth F.R.C.S.
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  5. D. Johnston F.R.C.S.
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  6. W. Lewis F.R.C.S.
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  7. A. Miller F.R.C.S.
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  8. P. Quirke M.R.C.Path.
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  9. M. Williamson F.R.C.S.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.

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Sagar, P.M., Taylor, B.A., Godwin, P. et al. Acute pouchitis and deficiencies of fuel. Dis Colon Rectum 38, 488–493 (1995). https://doi.org/10.1007/BF02148848

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  • DOI: https://doi.org/10.1007/BF02148848

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