Metabolic Adaptation of Terminal Ileal Mucosa After Construction of an Ileoanal Pouch

Background: The major nutrients for the large bowel and small bowel mucosa are, respectively, butyrate and glutamine. The degree of mucosal adaptation that may occur in response to changes in nutrient supply and faecal stasis after the formation of an ileoanal pouch is poorly understood.

Method: The ability of ileal mucosal biopsies, from nine patients with ulcerative colitis and from 18 with an ileoanal pouch, to oxidize [14C]-glucose, glutamine and butyrate to carbon dioxide was quantified.

Results: Glucose, glutamine and butyrate were oxidized respectively at a median of 12.5 (95 per cent confidence interval (4-22), 77 (34-207) and 194 (81-321) pmol microgram-1 h-1 by ileal mucosa and 12.9 (6-21), 35 (11-57) and 194 (73-737) pmol microgram-1 h-1 by pouch mucosa.

Conclusion: Ileoanal pouch construction and subsequent bacterial colonization and faecal stasis resulted in a significant (P < 0.05) reduction in the mucosal ability to oxidize glutamine whereas there was no difference in the rate of butyrate oxidation.