Irritable pouch syndrome is characterized by visceral hypersensitivity

Shen, Bo; Sanmiguel, Claudia P.; Bennett, Ana E.; Lian, Lei; Larive, Brett; Remzi, Feza H.; Fazio, Victor W.; Soffer, Edy E.

doi:10.1002/ibd.21412

Cited by 42 publications

(13 citation statements)

References 48 publications

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“…Rarely, de novo late-onset CD can occur in those with a history of UC. 130,131 Pouch Strictures Pouch strictures occur in approximately 11% of patients and could affect the inlet (afferent limb-junction with neoterminal ileum) or the pouch outlet (pouch-anal anastomosis). 130 EBD has been shown to be effective in management of anal strictures and anastomotic ileal pouch strictures-inlet and outlet.…”

Section: Pouchitismentioning

confidence: 99%

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

Tharian

George

Navaneethan

2016

Inflammatory Bowel Diseases

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The role of endoscopy in inflammatory bowel disease (IBD) has grown over the last decade in both diagnostic and therapeutic realms. It aids in the initial diagnosis of the disease and also in the assessment of the extent and severity of disease. IBD is associated with development of multiple complications such as strictures, fistulae, and colon cancers. Endoscopy plays a pivotal role in the diagnosis of colon cancer in patients with IBD through incorporation of chromoendoscopy for surveillance. In addition, endoscopic resection with surveillance is recommended in the management of polypoid dysplastic lesions without flat dysplasia. IBD-associated benign strictures with obstructive symptoms amenable to endoscopic intervention can be managed with endoscopic balloon dilation both in the colon and small intestine. In addition, endoscopy plays a major role in assessing the neoterminal ileum after surgery to risk-stratify patients after ileocolonic resection and assessment of a patient with ileoanal pouch anastomosis surgery and management of postsurgical complications. Our article summarizes the current evidence in the role of endoscopy in the diagnosis and management of complications of IBD.

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Section: Pouchitismentioning

confidence: 99%

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

Tharian

George

Navaneethan

2016

Inflammatory Bowel Diseases

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“…However, the data are conflicting, and the main papers in the literature have evaluated sensitivity in pouch patients. Shen et al 36 suggested that some patients have ‘irritable pouch’ because scores of sensation of gas, urge to defaecate, and pain sensation ratings at various distension pressures were significantly higher than in pouchitis and normal pouch patients. However, changes in pouch compliance may influence sensation and afferent hypersensitivity may not be the only cause of higher sensation.…”

Section: Is There Another Cause Of Persistent Symptoms When the Ibd Imentioning

confidence: 99%

Managing symptoms of irritable bowel syndrome in patients with inflammatory bowel disease

Camilleri

2011

Gut

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“…20 Its etiology and pathophysiology are not clear. It may be attributed to psychosocial factors, 20 visceral hypersensitivity as measured by electronic barostat, 92 and enterochromaffin cell hyperplasia of the pouch mucosa. 93 Currently, IPS is a diagnosis of exclusion.…”

Section: Irritable Pouch Syndromementioning

confidence: 99%

Diagnosis and Management of Postoperative Ileal Pouch Disorders

Shen

2010

Clinics in Colon and Rectal Surgery

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Although restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for patients with refractory ulcerative colitis (UC) or UC with dysplasia, surgical, inflammatory, and noninflammatory adverse sequelae are common. Pouchitis, representing a spectrum of disease phenotypes, is the most common long-term complication of IPAA. De novo Crohn disease (CD) of the pouch can occur in patients with a preoperative diagnosis of UC. Differential diagnosis between fibrostenotic or fistulizing CD and surgery-associated strictures, sinuses, and fistulas often requires a combined assessment of symptom, endoscopy, histology, radiography, and examination under anesthesia. There is a role for endoscopic therapy for stricturing complications of IPAA. Chronic antibiotic-refractory pouchitis, refractory cuffitis, as well as fibrostenotic or fistulizing CD of the pouch are the leading late-onset causes for pouch failure. KEYWORDS: Complication, ileal pouch, inflammatory bowel disease, restorative proctocolectomyObjectives: On completion of this article, the reader should be able to summarize the diagnosis, differential diagnosis, and management of complex ileal pouch disorders.Even if the era for biological therapy for inflammation bowel disease (IBD) has arrived, restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is still the surgical treatment of choice for the majority of patients with ulcerative colitis (UC) who fail medical therapy or develop dysplasia or neoplasia as well as for patients with familial adenomatous polyposis (FAP). Although this bowel-anatomy-altering procedure improves patients' health-related quality of life and substantially reduces the risk for UC-associated neoplasia, mechanical/surgical, inflammatory, and functional complications are common. Some of these complications can lead to pouch failure with pouch excision or permanent diversion. In a meta-analysis of 43 studies of 9,317 patients from mostly tertiary-care settings, the frequency of pouch failure was estimated to be 7% with a median follow-up of 37 months; the frequency increased to 9% after more than 60 months. The most common causes for early-onset pouch failure are pouch leaks, abscess, and pelvic sepsis.2,3 Whereas the leading causes for late-onset pouch failure are chronic pouchitis, Crohn disease (CD) of the pouch, 4 refractory cuffitis, 5 and chronic deep, complex pouch sinus.6 Recognition and appropriate diagnosis of these pouch-related conditions are imperative for proper management and prognosis.

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Irritable pouch syndrome is characterized by visceral hypersensitivity

Abstract: IPS, like other gut functional disorders, is characterized by visceral hypersensitivity, with normal pouch biomechanics.

Cited by 42 publications

References 48 publications

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

Managing symptoms of irritable bowel syndrome in patients with inflammatory bowel disease

Diagnosis and Management of Postoperative Ileal Pouch Disorders

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