Diversion proctocolitis and the problem of the forgotten rectum in inflammatory bowel diseases: A systematic review

Abstract

Background and aims: Diversion proctocolitis (DP) is a non-specific mucosal inflammation arising in the defunctionalized colon and/or rectum following faecal diversion (colostomy, ileostomy). Differential diagnosis of DP from the underlying disease in patients with inflammatory bowel diseases (IBD) is often unclear. As a result, it might be difficult to undertake any specific treatment. We aimed to systematically review the literature evidence on DP in IBD patients.Methods: For this qualitative systematic review, we searched PubMed, EMBASE and Scopus to identify all studies published until July 2021 including IBD patients affected by DP.Results: Overall, 37 papers published between 1982 and 2021 were included. A total of 1.211 IBD patients were included: 613 UC (50.6%), 524 CD (43.3%), 66 IBDunclassified (IBD-U) (5.4%), 8 unspecified patients (0.7%). Most patients with DP are asymptomatic, although inflammation is detectable in almost all patients with a rectal stump. Reduced short-chain fatty acids and an altered microbiome, may trigger mucosal inflammation and have been proposed as causing factors. An increased risk of developing cancer on DP has been reported in patients with a history of previous dysplasia/cancer. Conclusions:The etiopathogenesis of DP is still unknown. The efficacy of mesalamine, corticosteroids or short-chain fatty acids has not been proven by randomized trials yet. Since the incidence of cancer of the rectal stump can reach 4.5 per 1.000 diverted patients-year, IBD patients undergoing subtotal colectomy with end-ileostomy should undergo close endoscopic surveillance, being eventually counseled for surgery with or without the restoration of the intestinal continuity.

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“…It may sound seemingly obvious, but during the work as SoMe editor, the liberty appears the mainstay of unlimited creativity, including cowork with a graphic designer on visual abstracts, even journal website appearance improving. [8][9][10][11] In UEG Journal, the social media editor closely co-operates with Editor-in-Chief of UEG Journal and the whole UEG crew, working in very flexible time slots, following the SoMe editor's beat. In addition, this editor may work at various fronts, as an individual, but also as a team player to empower projects of UEG Journal like podcasts recording, and share them with the rest of the trainee editors under the UEG Journal board guidance.…”

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“…3 Although dyspepsia may be managed without endoscopy in primary care patients without alarm symptoms or risk factors, the presence of H. pylori needs to assessed and eradicated if positive 1 (Figure 1). Guidance for the 13 C-urea (UBT) and gastric emptying breath tests (GEBT) is also provided by the European guideline on the use of 13 C-breath tests from the European Association for Gastroenterology, Endoscopy and Nutrition, ESNM and European Society for Pediatric Gastroenterology Hepatology and Nutrition, among many other tests. 4 In this Delphi consensus with 43 experts from 18…”

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