Observations on essential biochemical data profile in connection with restorative proctocolectomy in humans : vitamin B12 and fat absorption cited

Abstract

PATIENTS: The material includes 99 patients who consecutively received handsawn pouch and ileoanal anastomosis, after mucosectomy. Sixty-five patients were men and forty-four were women. The mean-age was 31.4 (range 17-59) years. Fifty-nine patients initially underwent subtotal colectomy and ileostomy and 40 had colectomy at the time of pouch construction. Ninety-six patients suffered from ulcerative colitis, two had familial adenomatous polyposis and one was healthy but belonged to a dominant cancer inherited family. All patients obtained a loop ileostomy at the pouch operation. After loop ileostomy closure, the patients were followed up regarding homeostasis in a prospective fashion by the surgical team at 2, 6, 12, 18, 24 and 36 months after Surgery.

ELECTROLYTES: Pathologic values of sodium and potassium in serum were rarely seen. Low values of calcium were found preoperatively among acutely operated. Sixteen percent of the patients with ileostomy had high values of zinc, while 2% to 5% had low values during the manipulative and follow-up phases. Magnesium was decreased at all stations in 16 to 36% of the patients.

PROTEINS: Low albumin. values were seldom seen except for in patients who were to be acutely colectomized. In our observations, we noted an elevation of serum IgG and IgA with time during the functioning pouches after loop ileostorny closure and with serum IgM during the period with loop ileostomy, compared to preoperative values.

LIVER ENZYMES: A high percentage of patients had increased ALAT and/ or ALP in serum (36% and 42% respectively) during the time with loop ileostomy compared to a preoperative percentage of 14% and 12% in the elective group and 13% and 14% in the acute group. Fifty percent of the patients with increased ALAT also had increased ALP. The levels of mean values did not normalise until after closure of loop ileostomy.

HEMATOLOGY: More patients with low serum haemoglobin and iron were seen before colectomy (44% and 50%) than with ileostomy (18% and 23%) and/ or with loop ileostomy (12% and 16%). During the 6 to 36 months of IPAA follow-up, 7% to 14% and 11 to 21% had low values. Although only 3% and 11% of the ileal pouch anal anastomosed patient had low serum vitamin B12 at the 12 and 36 months follow-up, 31% and 36% had decreased Schilling test In five patients vitamin B12 deficiency began during the first 6 months of IPAA function. Ten percent of the patients have had substitutional therapy with vitamin B12. Five patients continue with substitution after 40 to 60 months. At 12 and 36 months follow-up, 35% and 41% had decreased 14C-triolein breath tests but no patient showed any symptoms of anorexia.

LIPIDS: There was a significant difference of mean serum cholesterol preoperatively. between patients who were operated on electively versus on emergency basis. In electively operated patients, serum levels of cholesterol decreased when patients had loop ileostomy. The decrease was significantly correlated to the length of the excluded ileum but not the time duration with loop ileostomy. During the same period, serum triglyceride was significantly increased, but there was no relation to the length of the diverted ileum.

Changed pattern of lipoproteins in serum was noted. Serum alpha-lipoprotein decreased (HDL) during the period with loop ileostomy. At 12 months after loop ileostomy closure, serum cholesterol, triglyceride and alpha, pre-beta- and beta-lipoprotein levels were not significantly changed compared to precolectomy time. In the emergency patients there was a tendency to increased serum cholesterol after colectomy with terminal ileostomy. After construction of the pouch and diverting loop ileostomy, serum cholesterol was not significantly changed while mean serum triglyceride was significantly increased compared to values prior to colectomy.

GASTRIC ACID SECRETION and GI HORMONES and ENZYME: There was a significant increase in retention basic, and stimulated gastric acid secretion after 12 months with pouch in function, compared to preoperatively. An increased output of gastric acids may change/ decrease the intestinal passage time and contribute to looser stool. The levels of serum gastrin, pentagastrin and pepsinogen were identical.