Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

Pembérton, John H.; Kelly, Keith A.; Beart, Robert W.; Dozois, Roger R.; Wolff, Bruce G.; Ilstrup, Duane M.

doi:10.1097/00000658-198710000-00011

Cited by 405 publications

(152 citation statements)

References 17 publications

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“…RP aims to remove the entire diseased colon and restore intestinal continuity by creating a neo-rectum with the terminal ileum [1,2]. It is a safe procedure with good functional outcome [3,4]. Assessment of the quality of life (QOL) of patients following RP has become a practical way of measuring the outcome of surgery [5,6].…”

Section: Research Lettersmentioning

confidence: 99%

Quality of life following restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis

Subasinghe¹,

Samarasekera

2010

Ceylon Med. J.

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Research lettersUlcerative colitis (UC) is a chronic inflammatory bowel disease and familial adenomatous polyposis (FAP) is a hereditary disease of the colon. Both FAP and long standing UC carry an increased risk of colorectal cancer (CRC). At present, restorative proctocolectomy (RP) is the surgical treatment of choice for UC and for all patients with FAP. RP aims to remove the entire diseased colon and restore intestinal continuity by creating a neo-rectum with the terminal ileum [1,2]. It is a safe procedure with good functional outcome [3,4]. Assessment of the quality of life (QOL) of patients following RP has become a practical way of measuring the outcome of surgery [5,6]. The aim of this small study was to evaluate the impact of RP on the QOL and to compare the QOL before and after RP for UC and FAP.QOL of all patients with UC and FAP who underwent RP over a period of 48 months was evaluated preoperatively and at 6 months and 1 year following surgery using the Cleveland global quality of life (CGQL) instrument [6]. This consists of 3 subcomponents, namely, current quality of life, current quality of health and current energy. Any difference of QOL (i.e. before and after surgery) was compared using Student's t-test and a p-value <0.05 was considered significant. 20 patients (UC=12, FAP=8) underwent RP during this period. There were 13 males and 7 females, median age 30.5 years (range, 17-52). The overall preoperative CGQL score of all patients was 0.602 and the scores at 6 months and 1 year post-surgery were 0.772 (p<0.05) and 0.917 (p<0.05) respectively.The mean overall CGQL score as well as its 3 subcomponents improved after surgery for ulcerative colitis. Compared to the preoperative score (0.464), they obtained significantly improved overall CGQL scores at 6 months (0.866, p<0.001) and at one year (0.949, p<0.001).The mean overall pre-operative CGQL for patients with FAP was 0.808. The average overall post-operative CGQL scores at 6 months and 1 year were 0.631(p=0.772) and 0.870 (p<0.05) respectively.In many studies the QOL after RP has been measured using non-validated QOL instruments [7,8] QOL in patients with UC or FAP. Overall CGQL scores in our study showed an improvement in the longer term. Major surgery such as RP sometimes has an adverse impact on the QOL in the short term, but tends to improve in the longer term. In our study, FAP patients showed a reduction in the overall CGQL score at 6 months, but the score improved at one year. This reduction of the QOL in post operative FAP patients may be because in FAP, unlike UC, it is most often asymptomatic individuals (i.e. following screening) who undergo prophylactic surgery. The subsequent increase in the score probably reflects improvement in pouch function in the long term, and to patients realising the benefits of cancer prevention. References

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Section: Research Lettersmentioning

confidence: 99%

Quality of life following restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis

Subasinghe¹,

Samarasekera

2010

Ceylon Med. J.

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“…There is much confusion surrounding pouchitis because the syndrome has not been tightly defined. The reported incidence of pouchitis varies widely between 7% and 42% (3,4,10,11,(41)(42)(43)(44)(45)(46)(47)(48)(49). This variation can partly be explained by whether or not endoscopic and histologic confirmation was required to establish a diagnosis of pouchitis (Table III).…”

Section: Pouchitismentioning

confidence: 99%

Clinical and Physiological Aspects of Ileal Pouch-Anal Anastomosis

Salemans

Nagengast

1995

Scandinavian Journal of Gastroenterology

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Salemans JMJI, Nagengast FM. Clinical and physiological aspects of ileal pouch-anal anastomosis. Scand J Gastroenterol 1995;30 Suppl 212:3-12.Proctocolectom y with ileal pouch-anal anastomosis is the surgical treatment of choice for severe chronic ulcerative colitis and familial polyposis coli because the entire colonic mucosa is removed while anal function can be preserved and the necessity for permanent ileostomy is eliminated. Long-term functional results are generally gratifying, as defecation frequency and degree of incontinence are acceptable in most patients. Pouchitis, however, a non-specific inflammation of the ileal reservoir, is a major long-term complication occurring in a considerable number o f patients. The etiology of pouchitis is unknown. Since pouchitis occurs more frequently or even exclusively in ulcerative colitis patients it is assumed that pouchitis is a novel manifestation o f inflammatory bowel disease. However, bacterial overgrowth in the ileal pouch may also play a pathogenetic role. Chronic inflammation and villous atrophy o f varying severity is found in virtually all pouches. Acute inflammatory changes and ulceration are associated with pouchitis.

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“…1,2 Pouchitis, a non-speci®c in¯ammation of the ileal reservoir, is the most frequent long-term complication following pouch surgery for ulcerative colitis. 3 This syndrome is characterized clinically by the presence of diarrhoea, rectal bleeding, faecal urgency, abdominal cramping, malaise and fever.…”

Section: Introductionmentioning

confidence: 99%

Long‐term efficacy of bismuth carbomer enemas in patients with treatment‐resistant chronic pouchitis

Gionchetti

Rizzello

Venturi

et al. 1997

Aliment Pharmacol Ther

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Background: Mucosal inflammation of the ileal pouch (pouchitis) is the major long‐term complication after ileal pouch‐anal anastomosis for ulcerative colitis. Broad‐spectrum antibiotics are the mainstay of treatment, however, 15% of patients with pouchitis have a chronic, treatment‐resistant disease. Aim: To determine the safety and efficacy of bismuth carbomer enemas in achieving and maintaining remission in treatment‐resistant chronic pouchitis. Methods: Twelve patients with treatment‐resistant chronic pouchitis were treated nightly for 45 days with enemas containing elemental bismuth complexed with carbomer. Diagnosis of pouchitis and response to treatment were evaluated with the Pouchitis Disease Activity Index (PDAI), which includes clinical, sigmoidoscopic and histological criteria. Serum bismuth concentrations were determined by atomic absorption. Results: Ten of 12 patients (83%) went into remission, with a significant decrease of mean total PDAI score from 12 (range 9–15) to 6 (4–15) (P < 0.002), and were continued on bismuth carbomer enemas administered every third night for 12 months. Patients were monitored clinically, sigmoidoscopically and histologically every 2 months for evidence of recurrence (increase ≥ 2 in the clinical symptom portion of the PDAI). Six of 10 patients (60%) were able to maintain remission throughout the 12‐month trial; 4/10 had an exacerbation, two of which occurred soon after discontinuing daily treatment. Serum bismuth levels were negligible in all patients and no side‐effects were registered. Conclusions: Our findings suggest that bismuth carbomer enemas are safe and effective in achieving and maintaining remission in patients with treatment‐resistant chronic pouchitis.

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Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

Cited by 405 publications

References 17 publications

Quality of life following restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis

Quality of life following restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis

Clinical and Physiological Aspects of Ileal Pouch-Anal Anastomosis

Long‐term efficacy of bismuth carbomer enemas in patients with treatment‐resistant chronic pouchitis

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