Incidence and Severity of Prepouch Ileitis

Samaan, Mark A; Jong, Djuna De; Sahami, Saloomeh; Morgan, Stephen J.; Fragkos, Konstantinos C.; Subramaniam, Sharmila; Kok, Klaartje; Makanyanga, Jesica; Barnova, I; Saravanapavan, Hajeena; Parisi, Ioanna; Di, Simona; Vega, Roser; Rahman, Farooq; Bloom, Stuart; Brink, Gijs R. van den; Löwenberg, Mark; Ponsioen, Cyriel Y.; Buskens, Christianne J.; Tanis, Pieter J.; Overstraeten, Anthony de Buck van; D’Hoore, André; Bemelman, Willem A.; D’Haens, Geert R.

doi:10.1097/mib.0000000000000593

Cited by 38 publications

(28 citation statements)

References 20 publications

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“…Despite lack of standard definition, PI is described as histologically evident mucosal inflammation extending beyond the reconstructed pouch up to 50 cm proximally in the afferent limb, and it is usually associated with endoscopically apparent erosions, ulcerations, erythema, and friability in the ileum that had appeared normal at endoscopy before undergoing the surgery [ 1 , 4 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of PI after RPC and IPAA ranged in two large studies from 4.4% to 6% [ 1 , 8 ]. PI occurs more frequently in patients who are young, who underwent early colectomy for UC, and who developed intestinal symptoms soon after undergoing RPC and IPAA, possibly because these factors are markers of biologically aggressive UC [ 1 , 7 ]. Smoking cigarettes does not significantly affect the rate or severity of PI, despite smoking ameliorates UC and pouchitis [ 1 , 2 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Restorative proctocolectomy (RPC) and ileal pouch anal anastomosis (IPAA) are the treatment of choice for ulcerative colitis (UC) refractory to medical therapy, for UC with severe dysplasia or colon cancer, and sometimes for familial adenomatous polyposis [ 1 – 4 ]. This surgery becomes necessary in 10-30% of patients within one decade after diagnosis of UC [ 1 ]. Outcomes are generally favorable, lasting up to 20 years [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Case Report and Literature Review Illustrating the Clinical, Endoscopic, Radiologic, and Histopathologic Findings with Prepouch Ileitis after IPAA and Restorative Proctocolectomy for Refractory Ulcerative Colitis

Shams

Seifeldin

Amin

et al. 2018

Case Reports in Gastrointestinal Medicine

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Prepouch ileitis (PI) is an uncommon complication of ileal pouch anal anastomosis (IPAA) and restorative proctocolectomy (RPC) for treatment of refractory ulcerative colitis (UC). A case is reported of PI in a 16-year-old girl who presented with severe UC that was initially stabilized with infliximab therapy but re-presented 1 year later with severe UC, refractory to infliximab and corticosteroid therapy, which required IPAA and RPC. Her symptoms resolved postoperatively, but she re-presented 1 year later with 10 loose, bloody, bowel movements/day and involuntary 6-Kg weight-loss. Computerized tomographic enterography showed focal narrowing and mucosal enhancement of the pouch and focal narrowing, abnormal mucosal enhancement, and mural thickening of the prepouch ileum. Pouchoscopy revealed exudates and ulcerations in both the pouch and prepouch ileum up to 50 cm proximal to pouch, as confirmed by histopathology of pouch and ileal biopsies. Capsule endoscopy revealed no small intestinal lesions beyond 50 cm from the pouch. She required antibiotics, hydrocortisone enemas, and eventually azathioprine to control her symptoms. She remains asymptomatic 4 years later while chronically administered azathioprine therapy. Comprehensive literature review demonstrates that this case illustrates the classical clinical, radiologic, endoscopic, and histopathologic findings in PI, a relatively rare syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case Report and Literature Review Illustrating the Clinical, Endoscopic, Radiologic, and Histopathologic Findings with Prepouch Ileitis after IPAA and Restorative Proctocolectomy for Refractory Ulcerative Colitis

Shams

Seifeldin

Amin

et al. 2018

Case Reports in Gastrointestinal Medicine

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“…It manifests endoscopically as erosions, ulcers, erythema, friability, and strictures. It is usually associated with pouchitis (115,116). The importance of recognizing and distinguishing PI from pouchitis alone is that PI appears to be an immune-mediated process not seen in FAP, is less responsive to antibiotic therapy, and is associated with a more severe course than pouchitis alone.…”

Section: Prepouch Ileitismentioning

confidence: 99%

A Personalized Approach to Managing Patients With an Ileal Pouch-Anal Anastomosis

Ardalan

Sparrow

2020

Front. Med.

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Quality of life after ileal pouch-anal anastomosis (IPAA) surgery is generally good. However, patients can be troubled by pouch-related symptoms and pouch disorders that can be inflammatory, mechanical/surgical, and functional. Management of patients with IPAA begins with measures to maintain a healthy pouch such as optimizing pouch function, providing tailored advice on a healthy diet and lifestyle, screening for and addressing metabolic complications of IPAA, pouch surveillance, and risk stratification for risk of pouchitis and pouch failure. Pouchitis is the most common inflammatory disorder. Primary pouchitis is a spectrum currently classified into three progressive phases-an antibiotic-responsive, an antibiotic-dependent, and an antibiotic-refractory phase. It is predominately microbially mediated in acute antibiotic-responsive pouchitis and predominately immune mediated in chronic antibiotic-refractory pouchitis (CARP). Secondary prophylaxis is recommended for recurrent antibiotic-responsive and for antibiotic-dependent pouchitis. Secondary causes of antibiotic-refractory pouchitis should be ruled out before a diagnosis of CARP is made. CARP is best classified as primary sclerosing cholangitis associated, immunoglobulin G4-associated, and autoimmune. Primary sclerosing cholangitis-associated CARP can be treated with budesonide or oral vancomycin. Early recognition of immunoglobulin G4-associated pouchitis minimizes ineffective antibiotic use. Autoimmune CARP can be managed in a manner similar to UC. The current place of immunosuppressives in the treatment algorithm depends on availability and early access to biological agents. Vedolizumab and ustekinumab are the preferred first-and second-line biologics for autoimmune CARP owing to their efficacy, better side effect profile, and low immunogenicity and need for concomitant immunomodulatory therapy. Antitumor necrosis factor should be reserved for autoimmune CARP failing the above and for CD of the pouch. There are no guidelines for the surveillance of pouches for dysplasia. Incidence varies based on a patient's risk. Since incidence is low, a risk-stratified approach is recommended.

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“…This has to be distinguished from pre-pouch ileitis if there is endoscopic disease found in the pre-pouch ileum, as the clinical course and treatment may vary. Pre-pouch ileitis is inflammation of the neoterminal ileum (also called pre-pouch or afferent limb) which has endoscopic and histological similarity to pouchitis [ 7 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Neoterminal Ileal Polyposis and Ulceration after Restorative Proctocolectomy with a Current Review of the Literature

Gorrepati

Rassaei

Clarke

2018

Case Rep Gastroenterol

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After ileal pouch anal anastomosis, one of the frequently encountered complications is polyposis of the pouch. We describe a case of proximal neoterminal ileal polyposis associated with deep ulceration suggestive of Crohn’s disease and review the available literature. A 36-year-old male presented with resistant pouchitis 11 years after surgery for ulcerative colitis. With all-negative initial workup, pouchoscopy showed multiple deep ulcers in the proximal ileum with some polyps. Biopsy of polyps showed inflammatory polyps with negative immunohistological staining for IgG pouchitis. With no treatable etiology for pouchitis and the presence of inflammatory polyps, there are no guidelines for surveillance of this condition. Definitive diagnosis is challenging and there is no consensus or recommended guidelines on the management.

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Incidence and Severity of Prepouch Ileitis

Cited by 38 publications

References 20 publications

Case Report and Literature Review Illustrating the Clinical, Endoscopic, Radiologic, and Histopathologic Findings with Prepouch Ileitis after IPAA and Restorative Proctocolectomy for Refractory Ulcerative Colitis

Case Report and Literature Review Illustrating the Clinical, Endoscopic, Radiologic, and Histopathologic Findings with Prepouch Ileitis after IPAA and Restorative Proctocolectomy for Refractory Ulcerative Colitis

A Personalized Approach to Managing Patients With an Ileal Pouch-Anal Anastomosis

Neoterminal Ileal Polyposis and Ulceration after Restorative Proctocolectomy with a Current Review of the Literature

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