Predictors of pouch failure: A tertiary care inflammatory bowel disease centre experience

Ricardo, Alison P.; Kayal, Maia; Plietz, Michael; Khaitov, Sergey; Sylla, Patricia; Dubinsky, Marla; Greenstein, Alexander J.

doi:10.1111/codi.16589

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…We found that 15% of patients with focal inflammation on initial endoscopy subsequently developed diffuse inflammation, suggesting that pouch monitoring for early detection of the endoscopic phenotype is an important component of strategies for maintaining healthy pouch condition. Patients with pouch fistula are known to have poor outcomes [ 6 ]. We identified 7 patients with pouch fistula and the proportion of diffuse inflammation of the pouch body was 71% in this group, suggesting fistulas developed due to chronic inflammation such as pouch with Crohn’s disease-like features [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, inflammation of the reservoir can develop, commonly termed “pouchitis.” [ 2 ] Several recent studies have reported a cumulative incidence of acute pouchitis is 30% and approximately 10% to 15% of patients with acute pouchitis develop chronic pouchitis in patients with UC [ 2 - 4 ]. Furthermore, the incidence of pouch failure requiring diverting loop ileostomy (DLI) or pouch excision is reportedly up to 10% and pouch with Crohn’s disease-like features is a significant risk factor of pouch failure [ 2 , 5 , 6 ]. Although the International Ileal Pouch Consortium has established several consensus guidelines for the management of pouchitis [ 7 , 8 ], there remains uncertainty regarding the monitoring, prophylaxis, and pathogenesis of pouchitis in UC.…”

Section: Introductionmentioning

confidence: 99%

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Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

Akiyama,

Onoda,

Moue

et al. 2024

Intest Res

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Background/Aims: Mucosal adaptation of the ileum toward colonic epithelium has been reported in pouchitis in ulcerative colitis (UC); however, the clinical characteristics, endoscopic findings, and outcomes in patients with pouchitis with ileal mucosal adaptation are poorly understood.Methods: This was a single-center retrospective study comprising UC patients treated by proctocolectomy with ileal pouch-anal anastomosis who had undergone pouchoscopy at the University of Tsukuba Hospital between 2005 and 2022. Endoscopic phenotypes were evaluated according to the Chicago classification. High-iron diamine staining (HID) was performed to identify sulfomucin (colon-type mucin)-producing goblet cells (GCs) in pouch biopsies. We compared clinical data between patients with (high HID group) and without > 10% sulfomucin-producing GCs in at least one biopsy (low HID group).Results: We reviewed 390 endoscopic examination reports from 50 patients. Focal inflammation was the most common phenotype (78%). Five patients (10%) required diverting ileostomy. Diffuse inflammation and fistula were significant risk factors for diverting ileostomy. The median proportion of sulfomucin-producing GCs on histological analysis of 82 pouch biopsies from 23 patients was 9.9% (range, 0%–93%). The duration of disease was significantly greater in the high HID group compared to the low HID group. The median percentage of sulfomucin-producing GCs was significantly higher in patients with diffuse inflammation or fistula compared to other endoscopic phenotypes (14% vs. 6.0%, <i>P</i>= 0.011).Conclusions: Greater proportions of sulfomucin-producing GCs were observed in endoscopic phenotypes associated with poor outcomes in UC, indicating patients with pouchitis showing colonic metaplasia of GCs may benefit from early interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

Akiyama,

Onoda,

Moue

et al. 2024

Intest Res

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“…42 Additional risk factors include preoperative CD, strictures, chronic pouchitis, fistulas, and persistent pouch dysfunction. 42,43 Preoperative biologic use, CLIPI, and prior pouch revision have also been found to be associated with higher failure rates. 43 More recently, CLIPI is being identified as an increasingly frequent cause of pouch failure at high-volume centers.…”

Section: Pouch Failure In Crohn's-like Ileal Pouch Illnessmentioning

confidence: 99%

“…42,43 Preoperative biologic use, CLIPI, and prior pouch revision have also been found to be associated with higher failure rates. 43 More recently, CLIPI is being identified as an increasingly frequent cause of pouch failure at high-volume centers. In fact, pouch failure occurs in up to 60% of pouch patients with CD, especially fistulizing disease with perianal involvement.…”

Section: Pouch Failure In Crohn's-like Ileal Pouch Illnessmentioning

confidence: 99%

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

Huang,

Abeshouse,

Lee

et al. 2024

Clin Colon Rectal Surg

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De novo Crohn's disease (CD) of the pouch or Crohn's-like Ileal Pouch Illness (CLIPI) is an increasingly common occurrence in an ever-growing ileal pouch population. Although currently undetermined if a subset of classic CD or a completely new entity, it primarily affects the prepouch afferent limb, pouch, and rectal cuff. Symptoms can mimic other more common disorders, such as pouchitis, and requires a thorough workup, including pouchoscopy with biopsy and often cross-sectional imaging, for the diagnosis to be made. There is an increased risk of long-term pouch failure in this population. Treatment is typically dependent upon the disease phenotype with surgical management considered in a step-up fashion. Medical management is primarily performed with “biologics,” such as antitumor necrosis factor agents, although data are limited due to the lack of randomized controlled trials. Surgical management for CLIPI can include endoscopic, anorectal, and abdominal approaches to assist as “pouch-salvage strategies.” The performance of advanced pouch-salvage techniques in the CLIPI population requires careful patient selection and should preferably be performed at high-volume pouch centers.

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“… 7 , 8 Construction of RPC-IPAA in these patients often is painstaking due to multiple postoperative complications and may result in pouch failure range from 5% to 18% when the ultimate diagnosis is CC with significant morbidity. 7 , 9 , 10 Change of diagnosis of IC to UC or CC is also observed in patients with IBD before colectomy, 11 , 12 as is the development of de novo Crohn’s ileitis after surgical intervention. 10 Incorrect diagnosis and treatment course carries potential morbidity from inappropriate and unnecessary surgeries, 8 , 13 and underscores the necessity of research efforts aimed at a more accurate diagnosis of the IBD.…”

Section: Introductionmentioning

confidence: 99%

Ubiquitous Colonic Ileal Metaplasia Consistent with the Diagnosis of Crohn’s Colitis among Indeterminate Colitis Cohorts

M'Koma,

Breaux,

Bragg

2023

MRAJ

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Background: Inadequate differentiated diagnostic features of predominantly colonic inflammatory bowel diseases i.e., ulcerative colitis and Crohn’s colitis, may lead to inexact diagnosis of “indeterminate colitis”. About 15% of indeterminate colitis patients are diagnosed at colonoscopy, in colonic biopsies, and/or at colectomy. Managing outcomes of indeterminate colitis, given its unpredictable clinical presentation, depends on future diagnosis of colitis, Crohn’s colitis or ulcerative colitis. Objective: Overview the diagnostic efficacy of ectopic colonic ileal metaplasia and human α-defens 5 (DEFA5 alias HD5) for accurate delineation of indeterminate colitis into authentic Crohn’s colitis and/ or ulcerative colitis. Design: We describe a targeted protein for potentially differentiating indeterminate colitis into an accurate clinical subtype diagnosis of inflammatory bowel diseases i.e., ulcerative colitis and Crohn’s colitis. Patients: Twenty-one patients with the clinically inexact diagnosis of indeterminate colitis were followed, reassessed and data analyzed. Main outcome measures: We observed that (i) some patients had their original diagnosis changed from indeterminate colitis to either ulcerative colitis or Crohn’s colitis; and (ii) human α-defensin 5 is aberrantly overexpressed in Crohn’s colitis. Results: Fifteen of the twenty-one (71.4%) patients with indeterminate colitis had their inconclusive diagnosis changed; nine patients changed to ulcerative colitis and six to Crohn’s colitis. In human colon surgical samples, Human α-defensin-5 was significantly upregulated in Crohn’s colitis. In addition, Human α-defensin 5 processing enzyme, matrix metalloptotease-7 was inversely expressed compared to Human α- Defensin 5. Limitation: Due to the sequence homology of the α-defensin class of proteins, preceding efforts to raise antibodies (Abs) against DEFA5 have limitations to produce adequate specificity. The Abs used in previous assays recognizes the α-defensins, active α-defensins 5 and inactive pro- α-defensins 5. Monoclonal antibodies (mAbs) to determine specificity and sensitivity of α-defensins 5, which is diagnostic of CC disease, and NOT other α-defensins is the limitation to overcome. Conclusion: It is feasible to differentiate ulcerative colitis from Crohn’s colitis among patients with inexact diagnosis of indeterminate colitis using Human α-defensin 5 as a molecular biosignature delineator.

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Predictors of pouch failure: A tertiary care inflammatory bowel disease centre experience

Cited by 7 publications

References 25 publications

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study

Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies

Ubiquitous Colonic Ileal Metaplasia Consistent with the Diagnosis of Crohn’s Colitis among Indeterminate Colitis Cohorts

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