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

Abstract

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. 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. 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 cm H(2)O 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. Ileal pouch function declines in the long term. The reasons are unclear, but the ageing process may have an impact.