Langzeitveranderungen des ileoanalen Pouch hinsichtlich Permeabilitat, bakterieller Permeation und Morphologie Long-term changes of ileoanal pouch concerning permeability, baderial translocation and morphology

More than 22 years the ileoanal pouch is the standard operation for the treatment of ulcerative colitis. Since there is only little knowledge about the long-term changes in ileoanal pouch the aim of this study was to examine the changes of older pouches concerning permeability, bacterial translocation and villus morphology. Material and Methods: Specimens were obtained from 20 patients after a period of more than 3 years (median 4.5 years) intact pouch in good function were compared with 15 specimens of pouchs less than 1 year, 15 healthy controls and 15 patients with pouchitis. Pouchitis was defined by the pouchitis disease activity index. Permeability was examined inside the Ussing chamber examining via impedance analysis epithelial (Re) and subepithelial resistance (Rsub) and mucosal transport function was examined by sodium glucose co­ transport. Bacterial permeation was also examined inside the Ussing chamber by a permeation experiment using an easy to reidentify ciprofloxacine resistant E. coli. Villus length and crypt depth were determined by microdissection after Clarke. Results: The results of the different statuses: pouch 3 years/pouchitis/healthy controls were: Re 16.2 ± 1.6116.1 ± 1.3112.3 ± 1.2114.8 ± 0.9[Q· cm'], R,ub: 14.0 ± 1.8/24.3 ± 1.5/ 21.9 ± 4.1/27.3 ± 6.5 [Q. cm2]; sodium-glucose-co-transport: 5.1 ± 1.5/5.5 ± 1.6/0.5 ± 0.3#/5.8 ± 1.5 [f.1I1101· h-1 • cm-2]; Bacteria translocated in (n translocatio/n total number): 0115113120*/8115*/0/10; villus-length: 382.5 ± 46.8/434.5 ± 76.2 242.6 ± 52.5*/502.3 ± 87.6 [f.1I11]; crypt depth: 211 ± 29.7/194.2 ± 27.7/211.5 ± 33.81178.4 ± 26.1 [f.1I11]. # P < 0.05 vs. Towards all subgroups, * p < 0.05 vs. control Conclusions: 1. Also older pouchs remain unchanged concerning their permeability, mucosal transport function and morphology. 2. Bacterial translocation increases with the age of the pouch. 3. The stability of the tight junction in mature pouchs is an argument against the paracellular pathway of bacteria. This fact supports the theory of trans epithelial bacterial passage via transcytosis.