Small Intestinal Transit Time and Intraluminal pH in Ileocecal Resected Patients with Crohn's Disease

Abstract

The pH and transit times of the gut areimportant for the delivery of active drug from severaltablets used in the treatment of Crohn's disease (CD).Many patients with CD undergo an ileocecal resection, which might influence small intestinal pH andtransit time. The effect of ileocecal resection on thesevariables has not previously been studied. IntraluminalpH and transit time were measured in nineileocecal-resected CD patients and 13 healthy volunteers usingpH-sensitive radiocapsules. Small intestinal transittime (SITT) was significantly shorter inileocecal-resected patients (5.2 hr, controls 8.0 hr).The pH levels of the small intestine were identical inpatients and controls, whereas cecal pH was 0.9 pH unitshigher in resected CD patients. The time spent with pHhigher than 5.5, 6.0, 6.5, and 7.0 was significantly shorter in patients than in controls. There wasno correlation between the SITT and the length ofresected ileum or between the SITT and the time elapsedsince the resection. We conclude that ileocecal resection decreases the SITT and the time withpH higher than 5.5-7.0. The study indicates that thisreduction of the SITT is mainly due to the resection ofthe ileocecal valve and is, to a certain extent, independent of the length of resected ileum. Anileocecal resection might therefore affect the deliveryof active drug from tablets with pH-dependentdelivery.