Fecal Calprotectin Is Increased in Pouchitis and Progressively Increases With More Severe Endoscopic and Histologic Disease

Ollech, Jacob; Bannon, Lian; Maharshak, Nitsan; Bar, Nir; Goren, Idan; Tulchinsky, Hagit; Yanai, Henit; Dotan, Iris

doi:10.1016/j.cgh.2021.11.012

Cited by 19 publications

(15 citation statements)

References 23 publications

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“…FC is a marker of endoscopic disease activity and is sensitive and responsive to disease change in patients with IBD. Previous studies assessing FC measurements in pouchitis have shown increased levels of FC in patients with an inflamed pouch (5–7,10), with increasing FC levels correlating with more severe endoscopic disease, a finding that was reproduced in this study. However, whether FC is a sensitive and rapid enough marker of change in disease activity in patients with a J-pouch has not been previously evaluated.…”

Section: Discussionsupporting

confidence: 77%

“…Fecal calprotectin (FC) is a sensitive noninvasive marker of bowel inflammation; it is also responsive to change in disease and endoscopic activity in patients with Crohn's disease and ulcerative colitis (UC) (2)(3)(4). FC is increased in pouchitis (5,6), with increasing levels associated with more severe endoscopic findings (7). However, whether it is responsive to change in disease activity and sensitive to endoscopic improvement is currently unknown (7).…”

Section: Introductionmentioning

confidence: 99%

“…FC is increased in pouchitis (5,6), with increasing levels associated with more severe endoscopic findings (7). However, whether it is responsive to change in disease activity and sensitive to endoscopic improvement is currently unknown (7). Similarly, there is a lack of data regarding the responsiveness of clinical quality of life questionnaires (short inflammatory bowel disease questionnaire [SIBDQ], inflammatory bowel disease [IBD] disk) commonly used in patients with classical inflammatory disease among patients with a J-pouch (8,9).…”

Section: Introductionmentioning

confidence: 99%

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Fecal Calprotectin and Quality of Life Questionnaires Are Responsive to Change in Pouch Disease Activity After Antibiotic Therapy: Results From a Prospective Clinical Trial

et al. 2022

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INTRODUCTION:Whether fecal calprotectin (FC) and quality of life (QoL) questionnaires reflect change in disease activity in patients with a J-pouch is unknown.METHODS:Patients with acute pouchitis were prospectively treated with a 2-week course of antibiotics. The full Pouchitis Disease Activity Index, FC, and QoL questionnaires were measured at baseline and after antibiotic therapy.RESULTS:Twenty patients were prospectively enrolled. After 2 weeks of antibiotic treatment, the Pouchitis Disease Activity Index decreased from a median of 9 to 5 (P = 0.007). FC decreased from a median of 661 ug/g to 294 ug/g (P = 0.02), and QoL questionnaires improved significantly.DISCUSSION:FC and QoL questionnaires reflect real-time changes in inflammatory pouch activity.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fecal Calprotectin and Quality of Life Questionnaires Are Responsive to Change in Pouch Disease Activity After Antibiotic Therapy: Results From a Prospective Clinical Trial

et al. 2022

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“…Despite the progress in elucidating some of the processes in the pathogenesis of inflammatory pouch disorders, there is an unmet need for improved biomarkers that can help assessing disease activity and predicting disease complications. Fecal calprotectin has emerged as a noninvasive test that was useful in distinguishing inflammatory from noninflammatory pouch disorders (71,72). When compared with the gold standard of pouchoscopy, calprotectin proved effective in ruling out inflammatory pouch disorders when ,100 mg/g (area under the curve 0.90) and ruling in inflammatory pouch conditions when $ 350 mg/g (area under the curve 0.90) (71).…”

Section: Future Directionsmentioning

confidence: 99%

Classification and Management of Disorders of the J Pouch

2023

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Total abdominal proctocolectomy with ileal pouch–anal anastomosis (IPAA) for ulcerative colitis (UC) is associated with substantial complications despite the benefits of managing refractory and/or neoplasia-associated disease. For the purpose of this review, we focused on the diagnosis of some of the most common inflammatory and structural pouch disorders and their respective management. Pouchitis is the most common complication, and it is typically responsive to antibiotics. However, chronic antibiotic refractory pouchitis (CARP) has been increasingly recognized, and biologic therapies have emerged as the mainstay of therapy. Crohn's-like disease of the pouch (CLDP) can affect up to 10% of patients with UC after IPAA. Medical options are similar to CARP therapies, including biologics with immunomodulators. Studies have shown higher efficacy rates of biologics for CLDP when compared with those for CARP. In addition, managing stricturing and fistulizing CLDP is challenging and often requires interventional endoscopy (balloon dilation and/or stricturotomy) and/or surgery. The implementation of standardized diagnostic criteria for inflammatory pouch disorders will help in advancing future therapeutic options. Structural pouch disorders are commonly related to surgical complications after IPAA. We focused on the diagnosis and management of anastomotic leaks, strictures, and floppy pouch complex. Anastomotic leaks and anastomotic strictures occur in approximately 15% and 11% of patients with UC after IPAA, respectively. Further complications from pouch leaks include the development of sinuses, fistulas, and pouch sepsis requiring excision. Novel endoscopic interventions and less invasive surgical procedures have emerged as options for the management of these disorders.

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“…41 Five studies reported rates of post-operative biologic use ranging from 5.8% to 33.0% (median 10%, IQR: 6.4-21.9%) with a mean follow-up of 9.4 years. 15,22,28,41,42 Six studies reported incidence of post-operative immunosuppression use ranging from 3% to 15.5% (median 6.75%, IQR: 3.2-9.3%) with a mean follow-up of 9.4 years. 15,22,28,41,42 Many patients post-IAPP remained on motility agents (loperamide, cholestyramine and domperidone), with rates reported as 47%, 43 50%, 44 66.2% 32 and 68.8%.…”

Section: Ongoing Medical Therapy Post-operativelymentioning

confidence: 99%

Review of long‐term complications and functional outcomes of ileoanal pouch procedures in patients with inflammatory bowel disease

Hassan

Connell

Rawal

et al. 2023

ANZ Journal of Surgery

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Background In medically refractory Ulcerative Colitis (UC), proctocolectomy with ileoanal pouch procedure (IAPP) is the preferred continence‐preserving surgical option. Functional outcomes post‐surgery and long‐term complication rates in the biologic era remain ambiguous. This review primarily aims to provide an update on these outcomes. Secondarily, risk factors associated with chronic pouchitis and pouch failure are explored. Methods Two online databases (MEDLINE and EMBASE) were searched on 4 October 2022 for English studies from 2011‐present relating to long‐term outcomes of IAPP in inflammatory bowel disease (IBD) patients. Adult patients with 12 month follow‐up were included. Studies focused on 30‐day post‐operative outcomes, non‐IBD patients or studies including less than 30 patients were excluded. Results Following screening and full‐text review of 1094 studies, 49 were included. Median sample size was n = 282 (IQR: 116–519). Median incidences for chronic pouchitis and pouch failure were 17.1% (IQR: 12–23.6%) and 6.9% (IQR: 4.8–10.8%), respectively. Upon multivariate analysis, chronic pouchitis development was most significantly associated with pre‐operative steroid use, pancolitis and extra‐intestinal IBD manifestations, whilst pouch failure was most significantly associated with pre‐operative diagnosis of Crohn's disease (compared to UC), peri‐operative pelvic sepsis and anastomotic leak. Overall patient satisfaction was very high with four included studies reporting greater than 90% satisfaction rates. Conclusion Long‐term complications for IAPP were common. However, despite this, patient satisfaction post‐IAPP was high. Up‐to‐date knowledge of complication rates and their risk factors improves pre‐operative counselling, management planning and patient outcomes.

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Fecal Calprotectin Is Increased in Pouchitis and Progressively Increases With More Severe Endoscopic and Histologic Disease

Cited by 19 publications

References 23 publications

Fecal Calprotectin and Quality of Life Questionnaires Are Responsive to Change in Pouch Disease Activity After Antibiotic Therapy: Results From a Prospective Clinical Trial

Fecal Calprotectin and Quality of Life Questionnaires Are Responsive to Change in Pouch Disease Activity After Antibiotic Therapy: Results From a Prospective Clinical Trial

Classification and Management of Disorders of the J Pouch

Review of long‐term complications and functional outcomes of ileoanal pouch procedures in patients with inflammatory bowel disease

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