Food intolerances following ileal pouch-anal anastomosis

Nutrition Research Newsletter, Oct, 2006

It is common for patients with inflammatory bowel disease to require surgery at some stage. Resection of the diseased segments is potentially curative in patients with ulcerative colitis. At present, the "gold standard" for patients undergoing colonic resection is an ileal pouch reconstruction. An ileal pouch maintains gastrointestinal continuity and transanal defecation, while allowing patients to avoid living with a permanent ileostomy following colectomy. The procedure, ileal pouch-anal anastomosis (IPAA), involves proctocolectomy and formation of a new reservoir using the distal ileum. The procedure is now performed with a low-complication rate, good functional results and quality of life, and excellent long-term outcomes. Long-term followup studies have shown that the majority of patients achieve complete continence following this procedure.

It is thought that most of these patients restrict their diet to avoid problems such as diarrhea or perianal irritation. The aim of an investigation was to make an inventory of gastrointestinal symptoms and their severity in patients after IPAA and to identify associated foods or food groups. Investigators also evaluated whether these symptoms changed over time.

A total of 105 patients from the Crohn's and Ulcerative Colitis Association of Netherlands served as subjects and completed a mailed survey. Participants provided data on body weight, height, adherence to a diet, medical history, and food intolerance. The food intolerance questionnaire was specifically developed for the current investigation and reflected the previous 2 weeks. The patients were asked using open-ended questions to name foods that increased or decreased the consistency of their stools, increased the number of bowel movements per day, increased flatulence, and caused perianal irritation. They were also asked to indicate on a scale from zero (absent) to 10 (severe) whether they experienced any of 15 gastrointestinal symptoms (for example, bloating or diarrhea). The questionnaire was completed with questions regarding bowel habits.

All subjects reported intolerance to one or more foods. Common symptoms included diarrhea (mean score = 5.8), fatigue (mean score = 5.5), and thirst (mean score = 4.6). Spicy foods, cabbage, and citrus fruits or juice were most likely to decrease stool consistency, increase stool frequency, or cause perianal irritation. Onions, cabbage, or leeks were reported by 28% of the patients to cause flatulence. The urge to defecate was stronger following a cooked meal (45% within half an hour) than after sandwiches (15% within half an hour). Foods reported to increase stool consistency were potato products, bread, and bananas.

This study indicates that food intolerance is a common, but mild, problem after IPAA. Nutrition professionals should encourage patients in this population to base their food choices on their own individual tolerance.

E. Steenhagen, N. De Roos, C. Bouwman, et al. Sources and severity of self-reported food intolerance after ileal pouch-anal anastomosis. J Am Diet Assoc; 106:1459-1462 (September, 2006). [Correspondence: Elles Steenhagen, RD, Department of Dietetics, HP G01.111, Heidelberglaan 100, Postbus 85500, 3508 GA Utrecht, The Netherlands. E-mail: e.steenhagen@umeutrecht.nl].