Relationship between gastrointestinal transit time and daily stool frequency in patients after Ileal J pouch-anal anastomosis for ulcerative colitis

Abstract

Background To investigate how the gastrointestinal transit function changes after ileal J pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and to study whether gastrointestinal transit time (GTT) has an influence on daily stool frequency, we investigated the relationship between GTT and stool frequency per day. Methods Forty patients with UC who had undergone restorative proctocolectomy, with ileostomy closure at least 48 to 120 months (mean 96.3) previously, and who had no preoperative and postoperative complications were recruited. They were divided into two groups on the basis of their stool frequency: 26 patients had a stool frequency of less than 6 times per day (group A: 16 men, 10 women; aged 15 to 59 years old, average 36.6) and 14 patients had a stool frequency of 7 or more times per day (group B: 10 men, 4 women; 24 to 56 years old, average 40.9). The GTTs using a radiopaque marker were studied. Interviews concerning the defecation states were performed at the examination. Results High nocturnal stool frequency was significantly noted more in group B than in group A ( P <0.001). All cases in group A and 12 cases in group B could discriminate flatus from feces, and there were significant differences between groups A and B ( P <0.05). Feeling of stool remaining was significantly noted more in group B than in group A ( P <0.01). Stool consistency in group A was harder than that in group B ( P <0.001). Patients with soiling were significantly noted more in group B compared with those in group A ( P <0.001). Incontinence was detected in only 2 cases in group B. Group A showed a better defecation state than group B. In the GTT study, the GTT was almost the same in groups A and B. The small bowel transit, pouch transit, and whole gut transit times in group B were faster than those of group A ( P <0.001). Removal length of the terminal ileum in patients after IPAA: patients in group B (13.8 ± 3.9 cm) had significantly more ileum removed compared with patients in group A (6.3 ± 2.4 cm; P <0.001). Regression lines in the relationship between removal length of the terminal ileum and individual stool frequency showed there was a correlation between removal length of the terminal ileum and individual stool frequency per day in direct proportion ( r = 0.79, P <0.001). A resection of more ileum, up to 15 cm, plays a role in increased stool frequency. Conclusions The present results suggested that rapid transit of both the small bowel and pouch may lead to a high stool frequency of 7 or more times per day with a poor defecation state after IPAA. It was also pointed out in this study that an important point is a resection of more ileum, up to 15 cm, plays a role in increased stool frequency.