Ileostomy Research Paper

INTRODUCTION

Ileostomy is an artificial opening in the ileum to divert faeces and flatus outside the abdomen where they can be collected in stoma bag. [1]

An ileostomy is created by bringing the terminal small bowel through a trephine incision preferably through the rectus muscle and then creating an everted sprout of 2-3 cms in length [2]

An ileostomy may be permanent or temporary depending upon their role [3]. There are various reasons for creating an ileostomy like intestinal obstruction, intestinal perforation with fistula formation or abscess, colon or rectal cancers, familial adenomatous polyposis, uncontrolled bleeding from large intestine, ischemic bowel disease, Inflammatory bowel disease (ulcerative colitis or crohn's disease), carcinoma

Historically there has been some discrepancy in defining “ileostomy diarrhoea” however it is generally defined as passage of greater than 1L /day of ileostomy output [12], with patients having to empty their ileostomy bags/pouches frequently.

Ileostomy diarrhoea is troublesome to both surgeons and patients, it affects the quality of life in patients as it is difficult for patients to ambulate and the pouch requires frequent emptying.

Several theories have been postulated as pathophysiology of ileostomy diarrhoea. These include loss of absorptive area, site of resection, length and functional status of remaining bowel, impaired absorption of bile acids and fat, rapid intestinal transit, bacterial overgrowth, malabsorption diseases (lactate deficiency, celiac disease), acute infectious enteritis, altered aldosterone and other hormonal regulations.

Loperamide is a potent Mu-opioid receptor agonist [13, 15] that acts on the myenteric plexus of the gut wall. It inhibits acetylcholine release from the myenteric plexus and inhibits the peristalsis. It also increases the tone of anal sphincter. Loperamide also inhibits the secretions directly by interacting with calmodulin, this may be responsible for the anti diarrheal action. [16]

Activating the Mu receptor prolongs the orocecal and colonic transit times by disrupting the gut’s electrical activity, increasing gut capacity, and delaying the passage of fluids through the small intestine, it has no direct effect on absorption [17] and when used to manage patients with ileostomy diarrhea investigators have obtained significant reduction in faecal loss, improvement in electrolytes and fluid balance have with loperamide therapy. [14, 33]

The reduction in intestinal motility and transit time with loperamide could improve the efficiency of the physiological mechanism and is effective in reducing high-output ileostomy. This will hasten the absorption of the medication before intestinal motility is initiated by the ingestion of food.