P0653 Patients with ileo-anal J-Pouch display altered, higher pouch contractility than controls as measured with motility MRI
Authors: Blad W , Menys A , Weston W , Dennis C , Naim I , Taylor S A 
Published: January 2025

Abstract

Background
After 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 but not placebo reduces bowel frequency1. 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.

Methods
30 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 sub-specalty radiologist (Entrolytics, Motilent, UK). Clinical observations were extracted from medical records by a sub-speciality 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 as seen on pouchoscopy, 3) compared frequency against pouch motility and finally 4) against symptoms via clinical assessment from patient notes. Non-parametric statistics were used.

Results
1. Mean pouch motility score was 157 (25 to 391) and in controls was 59 (23 to 104). Difference of 98, P = 0.002.
2. Patients with pouchoscopy were dichotomised into normal vs non-normal. Endoscopically normal pouch had motility of 185 vs 119, P = 0.05.
3. Based on Pouch Frequency, when dichotomised into =&gt;10 (bowel movements) and &lt;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.
4. 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.

Conclusion
J-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 Liraglutide1. A weaker association was seen with pouchoscopy and symptoms which may now be followed up in an appropriately powered study.

References
1.Herfarth, Hans MD, PhD, FACG1; Long, Millie D. MD, MPH, FACG1; Hansen, Jonathan J. MD, PhD1; Anderson, Chelsea PhD1; English, Emily BA, MSW1; Buse, John B. MD, PhD2; Barnes, Edward L. MD, MPH, FACG1. 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. The American Journal of Gastroenterology 119(9):p 1935-1938, September 2024. | DOI: 10.14309/ajg.0000000000002801