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PTH-260 Oral rehydration therapy to restore the water and electrolyte balance post-colectomy: results from a placebo-controlled randomised cross-over trial
  1. S Mallappa1,
  2. S Gabe2,
  3. RK Phillips1,
  4. MD Robertson3,
  5. SK Clark1
  1. 1The Polyposis Registry
  2. 2Gastroenterology and Intestinal Failure, St Mark’s Hospital, Harrow
  3. 3Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

Abstract

Introduction We have demonstrated metabolic disturbances and poor quality of life post-colectomy in patients with Familial Adenomatous Polyposis (FAP). We aimed to evaluate the efficacy of oral rehydration therapy (ORT) in restoring water and electrolyte balance post-colectomy.

Method A blinded placebo-controlled randomised cross-over trial was undertaken. Thirty patients with demonstrated hyperaldosteronism from on-going observational study were recruited. Patients were randomised to receive either placebo or ORT first in a cross-over trial with an intervening washout period. Patients attended clinical investigation day (CID) three times.

CID Fasting urine and blood samples were collected to measure sodium loss, hydration status and renin-angiotensin-aldosterone system (RAAS) activation. Quality of life (QoL) was assessed using SF-36 and FACIT-F questionnaires.

Full ethics approval was obtained and the trial has been registered (ISRCTN76735966).

Results i) Observational study: 70 patients who had undergone colectomy were recruited. 34 patients (49%) demonstrated fasting hyperaldosteronism (>250pmol/L) leading to higher urinary losses of potassium (p = 0.03) and creatinine (p = 0.01).

ii) Cross-over RCT

Biochemistry results

Data acquired so far in 16 patients (n = 48 CIDs) have demonstrated fasting plasma aldosterone concentration post-ORT to be significantly lower compared to baseline [189.25 (7.24) vs.536.25 (12.56) pmol/L; p = 0.05].

QoL results

SF-36–Post-ORT, patients reported an improvement in six of the eight dimensions of health (role physical, bodily pain, vitality, general health, social functioning and role emotional) with an overall improvement in both composite scores (physical and mental component summary scores)

FACIT-F–Post-ORT, patients reported higher scores on four of the five scales (physical well-being, social well-being, emotional well-being and fatigue scale) with higher total scores.

Conclusion Metabolic disturbances are common after colectomy leading to a poor quality of life. ORT forms a safe and effective intervention to correct the metabolic disturbances post-colectomy resulting in a positive impact on quality of life.

SOURCES OF FUNDING

Miss S Mallappa has been awarded a two year Royal College of Surgeons of England Surgical Research Fellowship funded by the IA support group (2012–2014).

Miss S Mallappa has also received seedcorn grants from St Mark’s Academic Institute.

Disclosure of interest None Declared.

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