Stem Jonathan, Heise Charles, Harms Bruce, Praska Corinne, Stalter Lily, Marka Nicholas, Carchman Evie
Division of GI Surgery, CB #7081, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599-7081, USA.
Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Int J Colorectal Dis. 2025 May 2;40(1):106. doi: 10.1007/s00384-025-04898-7.
This study aims to investigate the phenomenon of high-amplitude pouch contractile waves and their impact on functional results in patients undergoing ileal pouch-anal anastomosis following total proctocolectomy for ulcerative colitis.
This is an observational cohort study evaluating pouch manometric data at an early (study 1, < 6 months s/p ileostomy closure) and delayed (study 2, > 5 months after study 1) time point. High-amplitude contractions were defined as peaks ≥ 20 mmHg over baseline. Pouch functional measures and quality of life outcomes were correlated with contractile amplitude and frequency.
Thirty-three patients were included in this study. Contractile frequency decreased from study 1 to study 2 (0.14 vs. 0.07 contractions/min). Peristaltic contractility was absent in 18/33 patients (55%) on their early examination (study 1) after stoma takedown and 23/33 patients (70%) on study 2. A significant association was observed between increased pouch contraction and nighttime spotting (p = 0.05) during study 1. Increased amplitude was associated with increased nighttime spotting (p = 0.03) and an increased number of 24-h bowel movements (p = 0.038) during study 1. There were no significant associations with pouch function with study 2. Contractions had no significant impact on quality-of-life outcomes.
Nighttime spotting is associated with increased contractile frequency and amplitude early in pouch life following ileostomy takedown. Contractility decreases over time, with no evidence of contractile waves in the majority of patients at greater than 1 year post-IPAA. High-amplitude contractility is an additional factor contributing to early pouch functional results.
本研究旨在调查高振幅袋状收缩波现象及其对溃疡性结肠炎全直肠结肠切除术后行回肠袋肛管吻合术患者功能结果的影响。
这是一项观察性队列研究，在早期（研究1，回肠造口关闭后<6个月）和延迟期（研究2，研究1后>5个月）评估袋状测压数据。高振幅收缩定义为峰值比基线≥20 mmHg。袋状功能指标和生活质量结果与收缩幅度和频率相关。
本研究纳入了33例患者。收缩频率从研究1到研究2下降（0.14次/分钟对0.07次/分钟）。在造口拆除后的早期检查（研究1）中，18/33例患者（55%）无蠕动收缩，在研究2中为23/33例患者（70%）。在研究1期间，观察到袋状收缩增加与夜间便血之间存在显著关联（p = 0.05）。在研究1期间，幅度增加与夜间便血增加（p = 0.03）和24小时排便次数增加（p = 0.038）相关。研究2与袋状功能无显著关联。收缩对生活质量结果无显著影响。
夜间便血与回肠造口拆除后袋状早期生活中收缩频率和幅度增加有关。收缩力随时间下降，在IPAA术后1年以上的大多数患者中没有收缩波的证据。高振幅收缩力是影响早期袋状功能结果的另一个因素。
