Clinical & laboratory studies in ileoanal pouches

• Main Author: Evgenikos, Nikolaos
• Published: University of Edinburgh 1999
• Subjects: 616.3
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.650423

A whole gut lavage study performed in pouch patients showed that there is gut protein loss in ileoanal pouches similar to that in IBD. This protein loss relates to disease activity and may be used as an objective indicator of disease activity in ileoanal pouches. The protein loss is evident in the first few months of pouch function and may settle at a later stage. The whole gut lavage method allowed measurements of haemoglobin in the lavage specimen. This whole gut lavage haemoglobin also coincides with the protein loss. The bleeding however did not relate to the protein loss in all cases. Cytokine activity in the form of raised IL-1β and IL-8 in the whole gut lavage seems to accompany the gut proteins loss. Luminal neutrophilia measured by whole gut lavage neutrophil granulocyte elastase relates to the IL-8 levels. This observation was initially described in whole gut lavage studies in ulcerative colitis. Luminal neutrophilia was apparent in some cases of high protein loss at a level much higher than noticed in ileostomy patients. Luminal neutrophilia again has been previously shown to be a feature of active ulcerative colitis or active Crohn's colitis but not of active small bowel Crohn's disease. In an attempt to analyse possible chemotactic activity of the luminal contents, the method of neutrophil polarisation assay was evaluated and applied to whole gut lavage samples. The assay is based on the observation that when a culture medium is devoid of chemotactic factors, neutrophils remain spherical; with addition of chemoattractants, neutrophils acquire a polarised morphology. The use of this assay in gut fluid was the first ever attempt to use this assay in the gut.