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

Okita, Yoshiki; Araki, Toshimitsu; Hashimoto, Kiyoshi; Kondo, Satoru; Kawamura, Mikio; Koike, Yuki; Otake, Kohei; Fujikawa, Hiroyuki; Inoue, Mikihiro; Ohi, Masaki; Inoue, Yasuhiro; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato

doi:10.1159/000353151

Cited by 22 publications

(13 citation statements)

References 61 publications

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“…No relevant RCTs were retrieved. Nine and 11 observational studies were selected for the analysis of chronic pouchitis and overall pouchitis respectively in relation to EIMs ( Table S1 , supporting information), and six and ten studies respectively in relation to PSC ( Table S2 , supporting information). One study included both ulcerative colitis and familial polyposis.…”

Section: Resultsmentioning

confidence: 99%

“…Although PSC is one of the most frequently occurring EIMs in Western countries, the incidence of PSC is reported to be lower in Japan. In three articles from Japan, the incidence of PSC was too low to be incorporated in the pooled analysis assessing the effect of PSC on the development of pouchitis. Two Western studies investigated the effect of PSC and EIMs on the development of pouchitis.…”

Section: Discussionmentioning

confidence: 99%

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Meta‐analysis of the association of extraintestinal manifestations with the development of pouchitis in patients with ulcerative colitis

et al. 2019

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Background The presence of extraintestinal manifestations may be associated with the development of pouchitis in patients with ulcerative colitis after ileal pouch–anal anastomosis. The aim of this study was to assess this correlation. Methods A systematic literature search was performed using MEDLINE and the Cochrane Library. Studies published in English up to 22 May 2017 investigating the association between extraintestinal manifestations and development of pouchitis in adults with ulcerative colitis were included. Case reports were excluded. The association of extraintestinal manifestations with the development of overall and chronic pouchitis was investigated using a random‐effects model. Results Of 1010 citations identified, 22 observational studies comprising 5128 patients were selected for analysis. The presence of extraintestinal manifestations was significantly associated with both chronic pouchitis (odds ratio 2·28, 95 per cent c.i. 1·57 to 3·32; P = 0·001) and overall pouchitis (odds ratio 1·96, 1·49 to 2·57; P < 0·001). Conclusion The presence of extraintestinal manifestations is associated with development of pouchitis after ileal pouch–anal anastomosis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of the association of extraintestinal manifestations with the development of pouchitis in patients with ulcerative colitis

et al. 2019

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“…73,74 A retrospective report in the largest series in Japan consisted of 772 patients with UC observed a 10% cumulative incidence of pouchitis at 10 years after surgery, 75 but it seemed to be a little lower than recent reports. Okita et al 76 reported that chronic pouchitis occurred in 28% of patients who underwent IPAA. Our recent data also indicate that the cumulative incidence at 10 years after IPAA is approximately 30% and 20% for overall and chronic pouchitis, respectively.…”

Section: Incidence Of Pouchitis Among Different Countriesmentioning

confidence: 99%

Pouchitis after ileal pouch‐anal anastomosis in ulcerative colitis: Diagnosis, management, risk factors, and incidence

Hata

Ishihara

Nozawa

et al. 2016

Digestive Endoscopy

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Restorative proctocolectomy with ileal pouch-anal anastomosis has been the surgical treatment of choice for patients with ulcerative colitis who require surgery. Quality of life after this procedure is satisfactory in most cases; however, pouchitis is a troublesome condition involving inflammation of the ileal pouch. When a patient presents with symptoms of pouchitis, such as increased bowel movements, mucous and/or bloody exudates, abdominal cramps, and fever, endoscopy is essential for a precise diagnosis. The proximal ileum and rectal cuff, as well as the ileal pouch, should be endoscopically observed. The reported incidence of pouchitis ranges from 14% to 59%, and antibiotic therapy is the primary treatment for acute pouchitis. Chronic pouchitis includes antibiotic-dependent and refractory pouchitis. Intensive therapy including antitumor necrosis factor antibodies and steroids may be necessary for antibioticrefractory pouchitis, and pouch failure may occur despite such intensive treatment. Reported risk factors for the development of pouchitis include presence of extraintestinal manifestations, primary sclerosing cholangitis, non-smoking, and postoperative non-steroidal anti-inflammatory drug usage. In the present review, we focus on the diagnosis, endoscopic features, management, incidence, and risk factors of pouchitis in patients with ulcerative colitis who underwent ileal pouch-anal anastomosis.

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“…Pouchitis has been shown to be associated with a longer duration of colitis [62,63] and is more common in patients with pancolitis [62], those requiring steroids before colectomy [64] and those with extra-intestinal manifestations [63], more specifically primary sclerosing cholangitis (PSC) [65]. A meta-analysis has shown anti-neutrophil cytoplasmic antibody to be associated with an increased risk of developing chronic pouchitis but not acute pouchitis [66].…”

Section: The Problematic Pouchmentioning

confidence: 99%

Managing Intractable Proctitis and the Problematic Pouch

Kent

Keshav²

2014

Dig Dis

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Proctitis accounts for a significant proportion of cases of ulcerative colitis (UC), and some patients subsequently develop more extensive disease. However, most patients continue to have limited inflammation, although the changes in the distal colon and rectum can occasionally be severe, and symptoms of increased frequency, rectal bleeding and urgency can be as disabling as they are for patients with more extensive colitis. Furthermore, although symptoms are typically well controlled with standard medications, medically refractory proctitis poses particular problems. Patients generally are not systemically unwell, and there is no added fear of cancer. Therefore, the prospect of colectomy for such limited disease is resisted by patients, physicians and surgeons alike. Unusual therapies, often delivered locally by enema or suppository, have been tested in small case series without definitive outcomes. The pathogenesis of such limited, yet intractable inflammation remains unclear, and the differential diagnosis should be carefully reviewed to ensure that local disease, whether it is infectious, vascular, or a result of injury or degeneration, is not overlooked. Ileo-anal pouch formation is the surgery of choice for about 20% of patients with UC who undergo colectomy. In the majority of cases, this surgery results in an acceptable quality of life and freedom from a stoma. However, in a sizeable minority of cases, pouch dysfunction can cause intractable problems. The causes of pouch dysfunction are varied and must all be considered carefully, particularly in refractory cases. Pouchitis is a common issue and is usually transient and easily treated. However, refractory and chronic pouchitis can be challenging. Ischaemia, injury, infection and Crohn's disease can all cause refractory pouch dysfunction. In a minority of cases, there appears to be no apparent organic pathology, and the presumptive diagnosis is that of a functional pouch disorder. Although it is much rarer, neoplastic changes in the pouch must also be considered, and the risk managed appropriately. The management of both intractable proctitis and the problematic pouch is made more challenging by the wide differential diagnosis that must be considered and by the paucity of high-quality clinical trials to support any one therapy. Key strategies to overcoming these limitations include methodical and systematic investigation and review, and a willingness to tailor therapy to the individual patient. Clinical trials of new treatments should be supported, and data from the experience with small cohorts of patients should be meticulously collected, critically analysed and widely disseminated.

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

Cited by 22 publications

References 61 publications

Meta‐analysis of the association of extraintestinal manifestations with the development of pouchitis in patients with ulcerative colitis

Meta‐analysis of the association of extraintestinal manifestations with the development of pouchitis in patients with ulcerative colitis

Pouchitis after ileal pouch‐anal anastomosis in ulcerative colitis: Diagnosis, management, risk factors, and incidence

Managing Intractable Proctitis and the Problematic Pouch

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