Simple radiographic evaluation of ileoanal pouch volume

Managing Functional Disturbances in Patients with Inflammatory Bowel Disease

Functional disturbances occur in approximately 10% to 15% of the general population and in a similar percentage of patients with inflammatory bowel disease (IBD). Because overlapping irritable bowel syndrome (IBS) is so common, one of the most important interventions a clinician can make is recognizing its existence. This requires a thorough understanding of underlying pathophysiologic processes. Differentiating among the causes of symptoms is especially significant in a minority of patients mislabeled as having 'refractory IBD.' Escalating therapy directed at disease activity may have no effect on functional symptoms other than to reinforce their presence. Treatment of IBS in patients with IBD is similar to that of the general population. The cornerstone of treatment is establishing a constructive doctor-patient relationship. Initial therapy usually involves a conservative approach that includes patient education and diet and lifestyle modifications. Pharmacologic treatment is individualized and generally directed at the predominant symptoms. Options may broadly include antispasmodics, antidiarrheals, and antidepressants, either alone or in combination. Psychosocial therapies have shown to be beneficial in selected individuals.

Proposed association between ileoanal j-pouch perforation and rapid consumption of a high-calorie, high-fiber meal: report of two cases

PURPOSE

We report two cases of ileoanal J-pouch rupture after rapid consumption of high-fiber, high-calorie meals.

METHOD

We review the food intake, presentation, laboratory and radiographic data, and course of two patients who developed ileoanal J-pouch perforation after rapid consumption of meals rich in fiber or calories or both. The potential association between food consumption and rupture is explored.

RESULTS

The authors propose that the rapid ingestion of a high-fiber, high-calorie meal may lead to an acute intraluminal pressure elevation or a closed-loop obstruction. These effects may be the basis for an association between food ingestion patterns and perforation at the distal transection site in an ileoanal J-pouch.

CONCLUSION

The authors hypothesize that the rapid ingestion of a high-fiber, high-calorie meal may be associated with J-pouch perforation. Further investigative efforts are needed to confirm this association and to evaluate whether a causal relationship is present. If causality is established, physicians may develop a higher index of suspicion for pouch rupture in patients who present with abdominal disturbances after the rapid ingestion of a high-fiber, high-calorie meal.