Long-term function and manovolumetric characteristics after ileal pouch–anal anastomosis for ulcerative colitis

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Abstract

Background

Long-term pouch function and physiological characteristics after ileal pouch–anal anastomosis (IPAA) are poorly described. The aim of this study was to undertake a prospective investigation of long-term pouch function and manovolumetric characteristics.

Methods

Forty-two patients with a median follow-up of 16 years after IPAA were included. Function was assessed using a questionnaire and a score was calculated ranging from 0 to 15 (15 being the worst). Manovolumetry was performed and pouchitis recorded. A paired analysis was conducted, as the results were compared with previous data for each patient.

Results

The median functional score was 3·5 (range 0–10) at 2 years and 5 (range 1–11) at 16 years (P = 0·013). Resting anal canal pressures were higher (P < 0·001) and squeeze pressures lower (P = 0·008) at long-term follow-up. Ileal pouch volumes at distension pressures of 10, 20 and 40 cmH2O were diminished at 16 years (P < 0·001, P = 0·005 and P = 0·058 respectively). The volume and pressure for first sensation and urge to defaecate were reduced. Increased age correlated positively with a poor functional score. A history of pouchitis did not affect functional or physiological characteristics.

Conclusion

Ileal pouch function declines in the long term. The reasons are unclear, but the ageing process may have an impact.

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