Afferent limb ulcers predict Crohn’s disease in patients with ileal pouch-anal anastomosis☆

Wolf, Jason M.; Achkar, Jean–Paul; Lashner, Bret A.; Delaney, Conor P.; Petras, Robert E.; Goldblum, John R.; Connor, Jason T.; Remzi, Feza H.; Fazio, Victor W.

doi:10.1053/j.gastro.2004.02.019

Cited by 117 publications

(50 citation statements)

References 18 publications

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“…The diagnosis of inflammatory or fibrostenotic CD of the pouch was made after the exclusion of regular nonsteroidal antiinflammatory drug use at the time of diagnosis. 24 Fistulizing CD of the pouch was defined as having a fistula that developed 12 months after the ileostomy takedown in the absence of surgically related local complications such as abscess, leak, anastomotic separation, sinus, and pelvic sepsis, The lesions included perianal fistulae, pouch-vaginal fistulae, pouch-bladder fistulae, enterocutaneous fistulae, or pouch cutaneous fistulae.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Risk factors for pouch failure in patients with different phenotypes of Crohnʼs disease of the pouch

Shen

Remzi

Brzezinski

et al. 2008

Inflammatory Bowel Diseases

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Section: Diagnostic Criteriamentioning

confidence: 99%

Risk factors for pouch failure in patients with different phenotypes of Crohnʼs disease of the pouch

Shen

Remzi

Brzezinski

et al. 2008

Inflammatory Bowel Diseases

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“…The latter could be a sign of CD of the pouch. 15 EGD is the primary tool for gastroenterologists to evaluate upper GI pathology. EGD may have the following applications in patients with IBD: 1) Evaluation for CD of the upper GI-as up to 13% patients with CD had the disease involving upper GI tract involvement, 18,19 affecting the esophagus, 20 stomach, 21 or duodenum.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the previously published criteria with a combined assessment of pouch endoscopy, clinical features, histology, and in some patients, radiographic findings, diagnosis of normal pouch, irritable pouch syndrome, CD of the pouch, cuffitis, and surgery-associated complications (such as anastomotic strictures and leaks) was made. 14,15 The 18-point Pouchitis Disease Activity Index (PDAI) 16 instrument was used to diagnose pouchitis. Pouchitis was defined by a modified PDAI Ն5 points.…”

Section: Endoscopic Evaluationmentioning

confidence: 99%

Diagnostic Value of Esophagogastroduodenoscopy in Patients with Ileal Pouch–Anal Anastomosis

Shen

Remzi

et al. 2009

Inflammatory Bowel Diseases

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“…98 One study suggested that ulcers in the afferent limb of patients who had an IPAA procedure were predictive of CD. 102 Thus, when faced with a patient with severe pouch complications, knowledge of the patient's prior and current clinical, radiologic, endoscopic and pathologic information, the latter both in pouch and in pre-pouch proximal ileal mucosa, should be carefully examined before changing the patient's original diagnosis of UC to CD. 102 Under these circumstances, evaluation of the patient's prior biopsies and colectomy specimens for evidence of CD is considered essential.…”

Section: Attempt To Change the Diagnosis Of Uc To CD Based On Pouch Cmentioning

confidence: 99%

A contemporary and critical appraisal of ‘indeterminate colitis‘

Odze

2015

Modern Pathology

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Distinguishing ulcerative colitis (UC) from Crohn's disease (CD) is normally based on evaluation of a variety of clinical, radiologic, serologic and pathologic findings, the latter in biopsy and/or resection specimens. Unfortunately, some patients with IBD show overlapping pathologic features of UC and CD, which makes definite distinction between these two disorders difficult or even impossible. In most instances of uncertainty, the patient shows clinical and pathologic features of UC, but in addition, the patient's colon resection specimen reveals one or more CD-like features. In this setting, a diagnosis of indeterminate colitis (IC) is often rendered. IC is not a distinct disease entity, and, thus, it has no diagnostic criteria. The most common causes of uncertainty in IBD pathology that may lead to a diagnosis of IC in a colon resection specimen includes the presence of fulminant (severe and toxic) colitis, insufficient radiologic, endoscopic, or pathologic information (including analysis of prior biopsies) on the patient, failure to utilize major diagnostic criteria as hard evidence in favor of CD, failure to recognize unusual variants of UC and CD that may mimic each other, failure to recognize non-IBD mimics and other superimposed diseases that cause unusual pathologic features in a resection specimen, an attempt to distinguish UC from CD in mucosal biopsies of the colon and ileum, or an attempt to change the patients diagnosis (of UC or CD) based on pouch or diversion-related complications. Details of each of these causes of uncertainty are discussed, in detail, in this review article. A diagnosis of IC should never be made clinically or by pathologists based on evaluation of pre-resection colonic mucosal biopsies. Ultimately, the majority of indeterminate cases represent UC, and, thus, most of these patient can be treated safely with a colectomy combined with an ileal pouch anal anastomosis procedure.

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Afferent limb ulcers predict Crohn’s disease in patients with ileal pouch-anal anastomosis☆

Cited by 117 publications

References 18 publications

Risk factors for pouch failure in patients with different phenotypes of Crohnʼs disease of the pouch

Risk factors for pouch failure in patients with different phenotypes of Crohnʼs disease of the pouch

Diagnostic Value of Esophagogastroduodenoscopy in Patients with Ileal Pouch–Anal Anastomosis

A contemporary and critical appraisal of ‘indeterminate colitis‘

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