Journal Article

P114 Patients with ileo-anal J-pouch display altered, higher pouch contractility than controls as measured with motility MRI

Dennis, Chloe, Taylor, Stuart, Naim, Iyad, Blad, William, Weston, William, Menys, Alex

2025

Overview

BackgroundAfter colectomy, many patients with ileo-anal pouch anastomosis develop high bowel frequency and become refractory to antimotility agents despite normal pouch morphology. Recently it has been shown that Liraglutide reduces bowel frequency.1 We investigate the potential underlying contractility (hereafter referred to as ‘motility’) of the pouch with motility MRI (which measures regional peristalsis) in this retrospective study.Methods30 patients with ileoanal pouches (mean age 44 years, 9 female) and 10 controls (mean age 44, 5 male: 5 with non-colonic Crohn’s disease, 5 with ulcerative colitis) underwent standard MR Enterography including motility ‘cine’ imaging. All pouches were delineated by an experienced radiologist (Entrolytics, Motilent, UK). Clinical observations were extracted from medical records by a Gastroenterologist. Motility assessment of the pouch/rectum was performed using GIQuant (Motilent, London, UK) with a bowel wall contour placed at the pouch, to produce a numerical score for pouch/rectum wall motion. We 1) compared pouch against normal rectum, 2) compared pouch motility in the cohort separated by inflammation activity on pouchoscopy, 3) compared frequency against pouch motility and finally 4) against symptoms. Non-parametric statistics were used.ResultsMean pouch motility score was 157 (25 to 391) and in controls was 59 (23 to 104). Difference of 98, P = 0.002.Patients with pouchoscopy were dichotomised into normal vs non–normal. Endoscopically normal pouch had motility of 185 vs 119, P = 0.05.Based on Pouch Frequency, when dichotomised into =>10 (bowel movements) and <10 (bowel movements), pouch motility was 205 vs 116, a significant difference of 88 units P = 0.007 and correlation of bowel movements with motility showed positive relationship, Rho = 0.46, p =0.01.Based on Patient Reported Symptoms, dichotomised as ‘symptomatic’ vs ‘coping,’ pouch motility was 183 vs 132 with a non–significant difference of 50 units P = 0.1.Abstract P114 Figure 1A) patient with symptomatic J-pouch and high pouch motility B) and asymptomatic J-pouch C) showing similar distention but low motility[Figure omitted. See PDF]ConclusionJ-Pouch demonstrates markedly altered physiology with an elevated contractility phenotype, in terms of peristalsis, compared to disease-free controls. Pouch motility was associated with pouch frequency providing supportive mechanistic evidence for the efficacy of Liraglutide.1 A weaker association was seen with pouchoscopy and symptoms which may now be followed up in an appropriately powered study.ReferenceHerfarth H, Long MD, Hansen JJ, et al. Efficacy and safety of liraglutide in patients with an ileal pouch-anal anastomosis and chronic high bowel frequency: a placebo-controlled, crossover, proof-of-concept study. Am J Gastroenterol. 2024;119(9):1935-1938. doi:10.14309/ajg.0000000000002801

• Publisher: BMJ Publishing Group LTD
• Subject: Anastomosis / Contractility / Crohn's disease / Intestine / Magnetic resonance imaging / Medical records / Motility / Patients / Peristalsis / Phenotypes / Rectum / Surgical anastomosis / Ulcerative colitis