A Prospective Multivariate Analysis of Clinical Factors Associated With Pouchitis After Ileal Pouch–Anal Anastomosis

Fleshner, Phillip; Ippoliti, Andrew; Dubinsky, Marla; Ognibene, Steven J.; Vasiliauskas, Eric A.; Chelly, Marjorie; Mei, Ling; Papadakis, Konstantinos A.; Landers, Carol J.; Targan, Stephan R.

doi:10.1016/j.cgh.2007.03.020

Cited by 106 publications

(76 citation statements)

References 42 publications

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“…The implications of these studies include younger age at onset [10,15], younger age at colectomy [4], extensive colitis [12,17,18], backwash ileitis [4,8], extraintestinal manifestations [2,4,8,9,10,11], preoperative steroid use [13,23], smoking status [13,24,25], regular use of nonsteroidal anti-inflammatory drugs [14,24], preoperative perinuclear antineutrophil cytoplasmic antibody positivity [22,25,26], anti-CBir1 flagellin [22], and genetic factors (IL-1 receptor antagonist, NOD2/CARD 15, and TNF genes) [27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

“…[2,5,8,9,10,11,12,13,14,15,16]. Some of these studies evaluated predictive factors for the development of both acute and chronic pouchitis in combination [2,9,11], but other studies focused on predictive factors for acute and chronic pouchitis individually [8,10,12,13,14,15,17,18]. It was suggested that acute and chronic pouchitis may have different risk factors and pathogeneses [8,12,13].…”

Section: Introductionmentioning

confidence: 99%

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

Okita

Araki²,

Hashimoto³

et al. 2013

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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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Section: Discussionmentioning

confidence: 99%

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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“…Fleshner et al 16 , on the other hand, verified postoperative adverse effects in patients receiving corticoids.…”

Section: Upon Histological Assessment It Was Verified Thatmentioning

confidence: 99%

Influence of local or systemic corticosteroids on skin wound healing resistance

Alberti¹,

Vasconcellos

Petroianu³

2012

Acta Cir. Bras.

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PURPOSE:To compare the resistance of skin wound healing of mice submitted to local or systemic hydrocortisone administration, in different postoperative periods. METHODS:An incision and suture was performed on the thoracic skin of 130 male mice: Group 1 (n = 10) resistance of the integer skin; Group 2 (n = 30) submitted only to skin incision and suture; Group 3 (n = 30) skin incision and suture followed by administration of saline fluid; Group 4 (n = 30) skin incision and suture followed by administration of local hydrocortisone; Group 5 (n = 30) skin incision and suture followed by administration of systemic hydrocortisone. The resistance of the wound healing and the weight of the animals were studied on the seventh, 14 th and 21 st postoperative days. Histological examination was also performed. RESULTS:The mice that received corticoid (groups 4 and 5) presented significant decreasing on their weight (p = 0.02). The Groups 3, 4 and 5 showed lower scar resistance than Group 2 on the seventh postoperative day (p < 0.05). On the 14 th and 21 st days, there was no difference on the skin would healing resistance (p > 0.05). CONCLUSION:Administration of hydrocortisone in mice is responsible for weight decreasing and reduction of the skin wound healing resistance during the first postoperative week. MÉTODOS:Foram estudados 130 camundongos machos submetidos à incisão e sutura de pele da região dorsal do tórax: Grupo 1 (n = 10) resistência da pele íntegra; Grupo 2 (n = 30) incisão da pele e sutura, sem administração de corticóide; Grupo 3 (n = 30) incisão da pele e sutura, seguidas de injeção local de solução salina; Grupo 4 (n = 30) incisão da pele e sutura, seguidas de injeção local de hidrocortisona e Grupo 5 (n = 30) incisão da pele e sutura, seguidas de injeção intraperitoneal de hidrocortisona. Foram avaliadas a resistência cicatricial da pele e a variação ponderal no sétimo, 14º e 21º dias pós-operatórios, bem como sua histologia. RESULTADOS:Os camundongos que receberam hidrocortisona tiveram decréscimo ponderal (p = 0,02). Quanto à resistência cicatricial da pele, os Grupos 3, 4 e 5 apresentaram valor inferior ao Grupo 2, no sétimo dia pós-operatório (p = 0,031). No 14º e 21º dias, não houve diferença entre as tensões cicatriciais.CONCLUSÃO: A administração de hidrocortisona provoca redução ponderal em camundongos e a resistência cicatricial cutânea é menor na primeira semana pós-operatória.

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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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A Prospective Multivariate Analysis of Clinical Factors Associated With Pouchitis After Ileal Pouch–Anal Anastomosis

Cited by 106 publications

References 42 publications

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

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

Influence of local or systemic corticosteroids on skin wound healing resistance

Managing Intractable Proctitis and the Problematic Pouch

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