Lihi Godny © ECCO
|
Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is the surgery of choice for patients with refractory Ulcerative Colitis (UC). Following the first-year post operatively the pouch is adapted to the ileal content efflux and most patients have 5-8 bowel movements a day and one nocturnal. Stool and gas incontinence, episodic nocturnal soiling and use of anti-diarrheal medications are common1–4. Since patients often relate symptoms to food (especially fruit and vegetable, dairy products and spicy foods), food avoidance is prevalent in up to 70% of the patients5. Therefore, patients after pouch surgery should be routinely assessed and treated by a dietitian within the setting of a multidisciplinary team6.
Nutritional deficiencies including iron, vitamin B12 and vitamin D are common and should be monitored and addressed7. Fluids and electrolytes imbalances are common in patients with increased number of bowel movements and need to be managed in order to avoid dehydration.