Management of Patients with Ulcerative Colitis after Proctocolectomy:Pouchitis is a Real Danger

Abstract

Pouchitis develops in about 50% of the patients with ulcerative colitis (UC) undergoing colectomy. Aim:The aim of this study was to evaluate the frequency of pouchitis, to determine risk factors and to assess the efficacy of infliximab in refractory pouchitis.Patients and Methods: 76% of the 46 UC patients requiring colectomy underwent ileal pouch-anal anastomosis (IPAA) procedure. Demographic, clinical and therapeutic parameters were compared between patients who did and did not develop pouchitis and between those with pouchitis responding or being refractory to the conservative therapy.Results: 40% of the patients developed pouchitis. Six patients received infliximab therapy. Extraintestinal manifestation and non smoking was characteristic for refractory pouchitis.Discussion: Pouchitis developed in 40% of our patients undergoing IPAA. The development of pouchitis seems to be predisposed by frequent preoperative hospitalization. The earlier onset of pouchitis seems to be a prognostic factor for the unsuccessful conservative treatment and the need for biological therapy.