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Prospective Study of the Incidence, Timing, and Treatment of Pouchitis in 104 Consecutive Patients After Restorative Proctocolectomy

Prospective Study of the Incidence, Timing, and Treatment of Pouchitis in 104 Consecutive... Abstract Objective: To determine the incidence timing and effectiveness of treatment of symptomatic pouchitis following restorative proctocolectomy with ileal J-pouch anal anastomosis. Design: A cohort analytical study. Setting: University hospitals, a tertiary referral center; all subjects entered into the study followed up for a minimum of 12 months (mean follow-up, 40 months). Patients: One hundred four consecutive patients undergoing restorative proctocolectomy with ileal J-pouch anal anastomosis for either ulcerative colitis (n=97) or familial adenomatous polyposis (n=7) between June 1986 and December 1994. Interventions: Patients with symptomatic pouchitis were treated with either oral metronidazole or ciprofloxacin. Outcomes: Diagnosis of pouchitis was determined by clinical symptoms and confirmed with endoscopy. Response to oral antibiotics was determined by resolution of symptoms. Results: Fifty-two patients (50%) experienced at least 1 episode of pouchitis. The first episode of pouchitis occurred within the first 12 months after restoration of intestinal continuity in 56% of the cases. In 2 patients it occurred after 30 months. Response to antibiotic treatment was 96%. Two thirds of patients had multiple episodes. Chronic pouchitis occurred in 6 patients, necessitating pouch removal in 2. Conclusions: The incidence of pouchitis after ileal J-pouch anal anastomosis is approximately 50% with two thirds of these patients having multiple episodes. Chronic pouchitis occurs in a minority of patients. In chronic pouchitis, the risk of pouch loss is substantial.(Arch Surg. 1996;131:497-502) References 1. Melville DM, Ritchie JK, Nicholls RJ, Hawley PR. Surgery for ulcerative colitis in the era of the pouch: The St Mark's Hospital experience . Gut . 1994;35:1076-1080.Crossref 2. Kohler LW, Pemberton JH, Zinsmeister AR, Kelly KA. Quality of life after proctocolectomy: a comparison of Brooke ileostomy, Kock pouch, and ileal pouchanal anastomosis . Gastroenterology . 1991;101:679-684. 3. Cohen Z, McLeod RS. Proctocolectomy and ileoanal anastomosis with J-shaped or S-shaped ileal pouch . World J Surg . 1988;12:164-168.Crossref 4. Mignon M, Stettler C, Phillips SF. Pouchitis: a poorly understood entity . Dis Colon Rectum . 1995;38:100-103.Crossref 5. Fleshman JW, Cohen Z, McLeod RS, Stern H, Blair J. The ileal reservoir and ileoanal-anastomosis procedure: factors affecting technical and functional outcome . Dis Colon Rectum . 1988;31:10-16.Crossref 6. Everett WG. Experience with restorative proctocolectomy with ileal reservoir . Br J Surg . 1989;76:77-81.Crossref 7. Lohmuller JL, Pemberton JH, Dozois RR, Ilstrup D, VanHeerden J. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouchanal anastomosis . Ann Surg . 1990;211:622-629. 8. Pemberton JH. The problem with pouchitis . Gastroenterology . 1993;104:1209-1210. 9. Kartheuser AH, Dozois RR, Wiesner RH, LaRusso N, Ilstrup DM, Schleck CD. Complications and risk factors after ileal pouch-anal anastomosis for ulcerative colitis associated with primary sclerosing cholangitis . Ann Surg . 1993; 217:314-320.Crossref 10. Luukkonen P, Jarvinen H, Tanskanen M, Kahri A. Pouchitis: recurrence of the inflammatory bowel disease? Gut . 1994;35:243-246.Crossref 11. Sandborn WJ. Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis, and treatment . Gastroenterology . 1994;107:1856-1860. 12. Nicholls RJ, Moskowitz RL, Shepard NA. Restorative proctocolectomy with ileal reservoir . Br J Surg . 1985;72:S76-S79.Crossref 13. McIntyre PB, Pemberton JH, Beart RW, Devine RM, Nivatvongs S. Doublestapled vs handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis . Dis Colon Rectum . 1994;37:430-433.Crossref 14. Dozois RD, Kelly KA, Welling DR, et al. Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis . Ann Surg . 1989; 210:268-273.Crossref 15. Becker JM, Raymond JL. Ileal pouch-anal anastomosis: a single surgeon's experience with 100 consecutive cases . Ann Surg . 1986;204:375-383.Crossref 16. Bjarnason I, Williams P, Smethurst P, Peters TJ, Levi AJ. Effect of nonsteroidal anti-inflammatory drugs and prostaglandins on the permeability of the human small intestine . Gut . 1986;27:1292-1297.Crossref 17. Weissenborn U, Maedge S, Buettner D, Sewing KF. Indomethacin-induced gastrointestinal lesions in relation to tissue concentration, food intake and bacterial invasion in the rat . Pharmacology . 1985;30:32-39.Crossref 18. Fischer JE, Nussbaum MS, Martin LW, et al. The pull-through procedure: technical factors in influencing outcome, with emphasis on pouchitis . Surgery . 1993; 114:828-835. 19. Santos MC, Thompson JS. Late complications of the ileal pouch-anal anastomosis . Am J Gastroenterol . 1993;88:3-10. 20. Subramani K, Harpaz N, Bilotta J, et al. Refractory pouchitis: does it reflect underlying Crohn's disease? Gut . 1993;34:1539-1542.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Prospective Study of the Incidence, Timing, and Treatment of Pouchitis in 104 Consecutive Patients After Restorative Proctocolectomy

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430170043007
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine the incidence timing and effectiveness of treatment of symptomatic pouchitis following restorative proctocolectomy with ileal J-pouch anal anastomosis. Design: A cohort analytical study. Setting: University hospitals, a tertiary referral center; all subjects entered into the study followed up for a minimum of 12 months (mean follow-up, 40 months). Patients: One hundred four consecutive patients undergoing restorative proctocolectomy with ileal J-pouch anal anastomosis for either ulcerative colitis (n=97) or familial adenomatous polyposis (n=7) between June 1986 and December 1994. Interventions: Patients with symptomatic pouchitis were treated with either oral metronidazole or ciprofloxacin. Outcomes: Diagnosis of pouchitis was determined by clinical symptoms and confirmed with endoscopy. Response to oral antibiotics was determined by resolution of symptoms. Results: Fifty-two patients (50%) experienced at least 1 episode of pouchitis. The first episode of pouchitis occurred within the first 12 months after restoration of intestinal continuity in 56% of the cases. In 2 patients it occurred after 30 months. Response to antibiotic treatment was 96%. Two thirds of patients had multiple episodes. Chronic pouchitis occurred in 6 patients, necessitating pouch removal in 2. Conclusions: The incidence of pouchitis after ileal J-pouch anal anastomosis is approximately 50% with two thirds of these patients having multiple episodes. Chronic pouchitis occurs in a minority of patients. In chronic pouchitis, the risk of pouch loss is substantial.(Arch Surg. 1996;131:497-502) References 1. Melville DM, Ritchie JK, Nicholls RJ, Hawley PR. Surgery for ulcerative colitis in the era of the pouch: The St Mark's Hospital experience . Gut . 1994;35:1076-1080.Crossref 2. Kohler LW, Pemberton JH, Zinsmeister AR, Kelly KA. Quality of life after proctocolectomy: a comparison of Brooke ileostomy, Kock pouch, and ileal pouchanal anastomosis . Gastroenterology . 1991;101:679-684. 3. Cohen Z, McLeod RS. Proctocolectomy and ileoanal anastomosis with J-shaped or S-shaped ileal pouch . World J Surg . 1988;12:164-168.Crossref 4. Mignon M, Stettler C, Phillips SF. Pouchitis: a poorly understood entity . Dis Colon Rectum . 1995;38:100-103.Crossref 5. Fleshman JW, Cohen Z, McLeod RS, Stern H, Blair J. The ileal reservoir and ileoanal-anastomosis procedure: factors affecting technical and functional outcome . Dis Colon Rectum . 1988;31:10-16.Crossref 6. Everett WG. Experience with restorative proctocolectomy with ileal reservoir . Br J Surg . 1989;76:77-81.Crossref 7. Lohmuller JL, Pemberton JH, Dozois RR, Ilstrup D, VanHeerden J. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouchanal anastomosis . Ann Surg . 1990;211:622-629. 8. Pemberton JH. The problem with pouchitis . Gastroenterology . 1993;104:1209-1210. 9. Kartheuser AH, Dozois RR, Wiesner RH, LaRusso N, Ilstrup DM, Schleck CD. Complications and risk factors after ileal pouch-anal anastomosis for ulcerative colitis associated with primary sclerosing cholangitis . Ann Surg . 1993; 217:314-320.Crossref 10. Luukkonen P, Jarvinen H, Tanskanen M, Kahri A. Pouchitis: recurrence of the inflammatory bowel disease? Gut . 1994;35:243-246.Crossref 11. Sandborn WJ. Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis, and treatment . Gastroenterology . 1994;107:1856-1860. 12. Nicholls RJ, Moskowitz RL, Shepard NA. Restorative proctocolectomy with ileal reservoir . Br J Surg . 1985;72:S76-S79.Crossref 13. McIntyre PB, Pemberton JH, Beart RW, Devine RM, Nivatvongs S. Doublestapled vs handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis . Dis Colon Rectum . 1994;37:430-433.Crossref 14. Dozois RD, Kelly KA, Welling DR, et al. Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis . Ann Surg . 1989; 210:268-273.Crossref 15. Becker JM, Raymond JL. Ileal pouch-anal anastomosis: a single surgeon's experience with 100 consecutive cases . Ann Surg . 1986;204:375-383.Crossref 16. Bjarnason I, Williams P, Smethurst P, Peters TJ, Levi AJ. Effect of nonsteroidal anti-inflammatory drugs and prostaglandins on the permeability of the human small intestine . Gut . 1986;27:1292-1297.Crossref 17. Weissenborn U, Maedge S, Buettner D, Sewing KF. Indomethacin-induced gastrointestinal lesions in relation to tissue concentration, food intake and bacterial invasion in the rat . Pharmacology . 1985;30:32-39.Crossref 18. Fischer JE, Nussbaum MS, Martin LW, et al. The pull-through procedure: technical factors in influencing outcome, with emphasis on pouchitis . Surgery . 1993; 114:828-835. 19. Santos MC, Thompson JS. Late complications of the ileal pouch-anal anastomosis . Am J Gastroenterol . 1993;88:3-10. 20. Subramani K, Harpaz N, Bilotta J, et al. Refractory pouchitis: does it reflect underlying Crohn's disease? Gut . 1993;34:1539-1542.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1996

References