Pouchitis

Yu, Enda; Shao, Zhuo; Shen, Bo

doi:10.3748/wjg.v13.i42.5598

Cited by 43 publications

(32 citation statements)

References 36 publications

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“…The most popular present theory explains pouchitis as a recurrence of ulcerative colitis [20]. This is supported by the fact that in the 2 conditions the changes in the intestinal mucosa have a similar endoscopic and microscopic picture, as well as similar immunology, with the activation of the same pro-inflammatory cytokines and a similar response to antibiotic treatment.…”

Section: Discussionmentioning

confidence: 49%

“…Inflammation of the intestinal pouch -"pouchitis" -is the most common late complication of restorative proctocolectomy and its prevalence increases with the passage of time after ileostomy closure. It is currently believed that about 50% of patients operated on for ulcerative colitis will experience at least one episode of pouchitis [20]. Chronic inflammation is seen in 10-15% of intestinal pouches [21].…”

Section: Discussionmentioning

confidence: 99%

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Ileal Pouch Morphology and Microbiology in Ulcerative Colitis Patients

et al. 2015

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Background. Ideal pouch created during restorative proctocolectomy is a new gastrointestinal organ -"neorectum". Although it is made from the ileum, it takes over function of the removed rectum. This new function results in significant morphological changes in pouch's mucous membrane, which becomes similar to the large bowel mucosa. The most common pathology of the ileal pouch is its inflammation -pouchitis. One of the suspected causes of pouchitis is bacterial flora disturbance. Objectives. The aim of the study was to analyze the morphological and microbiological changes in ileal pouches in different time periods after ileostomy closure and to evaluate the influence of certain bacterial strains on the degree of inflammation. Material and Methods. The study involved 47 patients who had been treated surgically; they were investigated before and at different stages after ileostomy closure. They underwent repeated rectoscopies with biopsies of pouch mucosa and swabs for microbiological examination. In total 89 rectoscopies were performed, which provided 70 histopathological results according to the Heidelberg Pouchitis Activity Score and 87 microbiological test results. Results. The assessment of the morphology of intestinal pouches showed increased signs of chronic inflammation as the length of time after the closure of a protective ileostomy increased. There was no correlation between the signs of acute inflammation and the length of time after surgery; there were more signs of acute inflammation in cases of pouchitis. The composition of the bacterial flora of intestinal pouches changed as the length of time after ileostomy closure increased, with significant increases in the number of enterobacteriaceae species. The presence of Staphylococcus aureus significantly correlates with a higher degree of chronic inflammation; this bacterium may be a potential infectious factor in pouchitis. Conclusions. Microbiological analysis of intestinal pouch lumen is a useful tool that can be used in routine follow-up assessment of intestinal pouches as well as in diagnosing pouchitis (Adv Clin Exp Med 2015, 24, 2, 267-274).

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Ileal Pouch Morphology and Microbiology in Ulcerative Colitis Patients

et al. 2015

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“…Yu et al [19] stated that this inherent discrepancy among studies may be associated with the following factors: sample size, numbers of variables and outcomes, type of statistical analysis, diagnostic criteria for pouchitis, classification of pouchitis (acute vs. chronic entities), and type of controls.…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports revealed that a course of antibiotic-responsive pouchitis could evolve into antibiotic-dependent pouchitis followed by antibiotic-refractory pouchitis, and pouchitis subtypes were shown to change during follow-up [19,20]. Pouchitis encompasses a variety of disease processes that can change over time, which makes identification of predictive factors for this condition difficult.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for Development of Chronic Pouchitis after Ileal Pouch-Anal Anastomosis in Ulcerative Colitis

Okita

Araki²,

Hashimoto³

et al. 2013

Digestion

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Background: No previous studies have examined predictive factors for chronic pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) with consideration of changes in pouchitis subtypes during follow-up. This study evaluated the independent predictive factors for chronic pouchitis. Methods: A total of 244 consecutive patients who underwent IPAA were enrolled. We assessed the possible associations between pouchitis and clinical factors using Cox proportional hazard regression. Results: 231 patients met the inclusion criteria. 66 (28.5%) patients developed pouchitis. In 9 of 44 (20.4%) patients, antibiotic-responsive pouchitis at the first episode changed into chronic pouchitis after the occurrence of a subsequent episode. The median duration from occurrence of antibiotic-responsive pouchitis to alteration into chronic pouchitis was 502 (range 147-1,697) days. Overall pouchitis was finally classified into 35 acute pouchitis and 31 chronic pouchitis cases. Multivariate analysis revealed that a ≥7.5-g cumulative steroid dose before colectomy and a ≥500-mg monthly steroid dose just before colectomy were significant predictive factors for chronic pouchitis (p = 0.0001 and 0.0095, respectively). Conclusion: Patients with UC and a higher cumulative steroid dose before colectomy or higher monthly steroid dose just before colectomy may have a predictive factor for developing chronic pouchitis.

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“…The lifetime risk for colectomy surgery is 70%-80% for Crohn's disease patients and 20%-30% of UC patients [2] . In UC patients with colectomy, as many as 50% will develop at least one episode of pouchitis post-operatively [34] . The rationale, types of procedures, benefits and risks of surgery are reviewed by Hwang and Varma [35] .…”

Section: Treatment For Ibdmentioning

confidence: 99%

State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

McFarland¹

2008

WJG

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Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world. This issue of World Journal of Gastroenterology (WJG ) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions. Although great strides have been made in the diagnosis, treatment and pathology of IBS and IBD; much has yet to be explained. The etiologies and risk factors of these multifactorial conditions remain elusive. Specific diagnostic biomarkers need to be developed and safer treatments developed. The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs. IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics. Over one million people have IBD in the United States, with 30 000 new cases being diagnosed every year. One-quarter million people in the UK are afflicted with IBD. The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year. IRRITABLE BOWEL SYNDROME (IBS)Incidence of IBS IBS is a global problem and is more common in women than men. In developed countries, the prevalence of IBS ranges from 3%-25% of adults [1][2][3][4] and in the United States, IBS affects 15 million adults [5] . In the United Kingdom, IBS affects 10%-15% of the adult population [6] . The cost of direct and indirect medical care for IBS reached over $200 billion dollars in the United States [5,7] . Diagnosis of IBSAs there are no biologic markers for IBS, the diagnosis is usually based on symptoms and exclusion of other known causes of intestinal distress [6] . Unlike IBD, IBS does not cause severe inflammation, ulcers or other structural damage that aids the diagnosis of IBD. IBS is a functional disorder characterized by abdominal bloating, flatulence, abdominal pain and bowel dysfunction. The varying nature of symptoms and lack of structural abnormalities presents a diagnostic challenge. There are three main types of disease phenotypes: diarrhea-predominant (IBS-D), constipation-predominant (IBD-C) or alternating diarrhea-constipation (IBS-A). The diarrhea-predominant type is more common (48%) in males, whereas constipation-predominant (39%) or alternating types (48%) are more common in women [1] . Several tools (for example, Rome Ⅲ, Manning criteria) have been developed to standardize the diagnosis of IBS. Most of the historic research has been focused on the pathophysiology of diarrhea, but constipation has not been as well described. The review by McCrea and colleagues in this issue summarizes our current knowledge about the physiology and pathology of constipation [8] . The prevalence of constipation ranges from 15%-25% in the general population and is more common in women than men and in ages over 70 years old [9] . The typical definition of constipation (less than three stools/week) may not be a sensitive measure for this condition, as individuals vary widely in their own bowel habits. ...

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Pouchitis

Cited by 43 publications

References 36 publications

Ileal Pouch Morphology and Microbiology in Ulcerative Colitis Patients

Ileal Pouch Morphology and Microbiology in Ulcerative Colitis Patients

Predictive Factors for Development of Chronic Pouchitis after Ileal Pouch-Anal Anastomosis in Ulcerative Colitis

State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

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