Untitled

Abstract

This study evaluated whether twice daily isotonic perfusion of the bypassed ileum for six weeks would enhance its motor activity and its absorption of fluids, electrolytes, and vitamin B12. The study also determined if patients undergoing perfusion had improved bowel function and decreased hospital stay after ileostomy closure. Following proctocolectomy, ileal pouch-anal canal anastomosis, and diverting loop ileostomy, six patients self-infused an isotonic solution (sucrose and sodium chloride) into the bypassed ileum twice daily, while seven patients did not (controls). Two months following proctocolectomy, and just prior to ileostomy closure, a manometric catheter assembly was placed into the unused distal ileum via the stoma and the distal ileum perfused with an isotonic sodium chloride solution for 3 hr during fasting and 3 hr after a meal. Absorption was measured, single and clustered pressure waves were identified, and a motility index was calculated. Water absorption, motility index, and cluster parameters did not improve in perfused patients compared to controls during fasting or after a meal, nor did perfused patients have improved vitamin B12 absorption. The perfused patients also did no better clinically following ileostomy takedown; the onset of bowel movements, their frequency, time to tolerate a diet, and hospital stay were similar to controls. We conclude that six weeks of twice daily isotonic perfusion did not improve motor activity or water, electrolyte, and vitamin B12 absorption in the bypassed distal ileum after proctocolectomy, ileal pouch-anal canal anastomosis, and loop ileostomy. The perfusion also did not improve bowel function after ileostomy takedown.

Manometry of the Human Ileum and Ileocaecal Junction in Health, Disease and Surgery: A Systematic Review

“…The propagation velocity of regular phasic contractions appeared to be higher, with a mean of 30 cm/min. The motility index, based on the log definition, appeared slightly lower with mean values ranging from 8.1 to 10.0 (39,40).…”

“…Variability also existed in the quantitative criteria of each definition. Prolonged propagated contractions were described by most studies as a single wave with large amplitude and long duration but the minimum amplitude requirement ranged from 20 to 60 mmHg (32, 40) while the minimum duration requirement ranged from 6 to 12 s (40,46). In view of this variability, summary definitions were derived and displayed in Table 2.…”

“…Three studies defined the motility index as "log e (sum of amplitudes × number of contractions +1)" (30,39,40), one study described it as "log 10 (sum of amplitudes × number of peaks +1)" (32), four studies used the integration of the area under the pressure tracings (31,34,48,49) and one defined it as "[sum of log(amplitudes of contractions)]/number of contractions" (36).…”

“…Three studies utilized manometry in only the afferent limb of a loop ileostomy (20,23,24), four studies only investigated the efferent limb (16,(39)(40)(41) and one research team measured motility in both limbs (4). No direct comparisons between motility of the afferent and efferent limbs were made.…”

“…Researchers reported data for which there were no corresponding values in normal individuals to allow comparison. This included the mean amplitude of DCC [15.5-68.0 mmHg (4, 39)], the percentage of PPCs found to propagate [85% (39,40)], and the mean frequency of contractions of regular phasic contractions [7.0-8.6 per minute (16,20)]. Slow phasic contractions were found to have a mean duration of 18-20 s, a mean amplitude of 23-24 mmHg and 6-20% of contractions were found to propagate (16).…”