Difference in the frequency of pouchitis between ulcerative colitis and familial adenomatous polyposis: is the explanation in peripouch fat?

Xian, Gao; Li, J. Q.; Khan, Fatima; Chouhan, Hanumant; Yu, Guo; Remer, Erick M.; Stocchi, Luca; Hull, Tracy L.; Shen, Bo

doi:10.1111/codi.14651

Cited by 13 publications

(6 citation statements)

References 41 publications

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“…The reasons for a higher frequency of pouchitis in UC patients remain unknown. A recent study demonstrates that UC patients have more peri-pouch fat than FAP patients, which might, in part, explain their difference in prevalence of pouchitis and chronic antibiotic-refractory pouchitis [168].…”

Section: Structural Issues Of the Pouch Should Be Ruled Out In Patients With Pouchitis [El5] [Agreement: "Agree" 941% "Partially Agree" 5mentioning

confidence: 99%

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

et al. 2020

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The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a Position Statement of Italian colorectal surgeons to address the surgical aspects of ulcerative colitis management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of ulcerative colitis. The committee was able to identify some points of major disagreement and suggested strategies to improve the quality of available data and acceptance of guidelines.

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Section: Structural Issues Of the Pouch Should Be Ruled Out In Patients With Pouchitis [El5] [Agreement: "Agree" 941% "Partially Agree" 5mentioning

confidence: 99%

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

et al. 2020

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“…Quinn et al 6 published figures in their article that purport to illustrate pouchitis but which, in our opinion, show the "benign" sort of ulcer that happens commonly in ileal pouches as a result of the structural and physiological changes forced on the bowel. Gao et al 7 from our institution used a sample of patients with an ileal pouch and a CT scan to look for a relationship between "pouchitis" and mesenteric fat. Forty patients with FAP were included and compared to 277 with ulcerative colitis.…”

Section: Discussionmentioning

confidence: 99%

Nonspecific, Acute Pouchitis in Patients With Familial Adenomatous Polyposis: Less Common Than We Think

Abbass

Lavryk

Hyman

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Nonspecific acute pouchitis is common in patients with ulcerative colitis who undergo IPAA, but there is disagreement about the rate at which this occurs in patients with familial adenomatous polyposis. OBJECTIVE: This study aimed to define the rate at which nonspecific acute pouchitis occurs in patients with familial adenomatous polyposis. SETTING: This study was conducted at a hereditary colorectal cancer center in a large academic medical center. DESIGN: This is a retrospective cohort study using prospectively gathered data. PATIENTS: Patients with familial adenomatous polyposis who have had IPAA were included. INTERVENTIONS: Symptoms, pouchoscopy and pouch radiography, and pouch biopsy were evaluated. MAIN OUTCOME MEASURES: The primary outcomes measured were the presence of nonspecific acute pouchitis and the alternative diagnosis of pouch dysfunction. RESULTS: There were 250 patients with familial adenomatous polyposis who had undergone IPAA; 38 (15.2%) had been labeled as having “pouchitis”: 23 men and 15 women. Median age was 55 years (range, 18–90 years). No patient had nonspecific, acute pouchitis as defined by our criteria. In 9 cases, the diagnosis was derived from benign ulcers common in ileal pouches. Stool frequency was the most common symptom associated with the “pouchitis” label, but actual causes for the frequency included poor pouch emptying, poor eating habits, poor bowel habits, and afferent limb syndrome. Median stool frequency was 9, ranging from 4 to 15 per day. Every patient had at least 1 pouch endoscopy, and the median number was 19 per patient (range, 1–21). Nine patients had pouch biopsies to rule out inflammation; all showed chronic active enteritis, a normal finding in ileal pouches. LIMITATIONS: This study was limited by its retrospective nature. CONCLUSIONS: We could not confirm any case of nonspecific acute pouchitis in patients with familial adenomatous polyposis. Those caring for patients with familial adenomatous polyposis who have a pouch should seek causes for pouch-related symptoms other than “pouchitis.” See Video Abstract at http://links.lww.com/DCR/B666. POUCHITIS AGUDA INESPECÍFICA EN PACIENTES CON POLIPOSIS ADENOMATOSA FAMILIAR: MENOS COMÚN DE LO QUE PENSAMOS ANTECEDENTES: La pouchitis aguda e inespecífica es común en pacientes con colitis ulcerativa, sometidos a anastomosis de bolsa ileoanal, pero no hay acuerdo sobre la frecuencia en que se presenta en pacientes con poliposis adenomatosa familiar (PAF). OBJETIVO: Definir la frecuencia en la que se presenta pouchitis aguda inespecífica en pacientes con poliposis adenomatosa familiar. ENTORNO CLINICO: Centro de cáncer colorrectal hereditario en un gran centro médico académico. DISEÑO: Estudio de cohorte retrospectivo utilizando datos recopilados prospectivamente. PACIENTES: Pacientes con poliposis adenomatosa familiar sometidos a bolsa con anastomosis ileoanal. INTERVENCIONES: Síntomas, proctoscopia, radiografía y biopsia de bolsa ileoanal. PRINCIPALES MEDIDAS DE VALORACION: Presencia de p...

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“…45 A smaller amount of parapouch fat measured by CT in patients with IPAA for FAP than those for UC may explain why the former patient population has a lower risk for pouchitis than the latter patient population. 46…”

Section: S73mentioning

confidence: 99%

Radiographic Evaluation of Ileal Pouch Disorders: A Systematic Review

Shen,

Bruining,

2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Radiographic imaging of abdomen and pelvis plays an important role in the diagnosis and management of ileal pouch disorders with modalities including computed tomography, magnetic resonance imaging, contrasted pouchography, and defecography. OBJECTIVES: A systematic review of the literature was performed and applications of cross-sectional imaging, pouchography, defecography, and ultrasonography are described. DATA SOURCES: PubMed, Google Scholar, and Cochrane database. STUDY SELECTION: Relevant articles on endoscopy in ileal pouches published between Jan 2003 and June 2023 in English were included based on PRISMA guidelines. INTERVENTION: Main abdominal and pelvic imaging modalities and their applications in the diagnosis of ileal pouch disorders were included. MAIN OUTCOME MEASURES: Accuracy in characterization of the ileal pouch disorders. RESULTS: Computed tomography is the test of the choice for the evaluation of acute anastomotic leaks, perforation, and abscess(es). Magnetic resonance imaging of the pelvis is suitable for the evaluation of chronic anastomotic leaks and their associated fistulas and sinus tracts, as well as for the penetrating phenotype of Crohn’s disease of the pouch. Computed tomography enterography and magnetic resonance enterography are useful in the assessment of intraluminal, intramural, and extraluminal disease processes of the pouch and prepouch ileum. Water-soluble contrast pouchography is particularly useful for the evaluation of acute or chronic anastomotic leaks and outlines the shape and configuration of the pouch. Defecography is the key modality to evaluate structural and functional pouch inlet and outlet obstructions. Ultrasonography can be performed to assess the pouch in experienced IBD centers. LIMITATIONS: This is a qualitative, not quantitative review of mainly case series and case reports. CONCLUSIONS: Abdominopelvic imaging along with clinical and endoscopic evaluation is imperative for the accurate assessment of structural, inflammatory, functional, and neoplastic disorders. See video from symposium.

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Difference in the frequency of pouchitis between ulcerative colitis and familial adenomatous polyposis: is the explanation in peripouch fat?

Cited by 13 publications

References 41 publications

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

Nonspecific, Acute Pouchitis in Patients With Familial Adenomatous Polyposis: Less Common Than We Think

Radiographic Evaluation of Ileal Pouch Disorders: A Systematic Review

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