Iron-Deficiency Anemia as Presentation of Pouchitis

Pastrana, Rafael; Torres, Esther A.; Arroyo, J; Rivera, Cynthia; Sánchez, Carlos J.; Morales, Lilliana

doi:10.1097/01.mcg.0000212641.90477.d0

Cited by 33 publications

(23 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While bloody bowel movements are uncommon in typical pouchitis, patients with IPAA with or without pouchitis can have iron deficiency anemia [50,51] . Patients with severe pouchitis occasionally present with fever, dehydration, malnutrition which may require hospitalization.…”

Section: Clinical Presentationsmentioning

confidence: 99%

Pouchitis

Yu¹,

Shao²,

Shen³

2007

WJG

View full text Add to dashboard Cite

While restorative proctocolectomy with ileal pouch-anal anastomosis has significantly improved the quality of life in patients with underlying ulcerative colitis who require surgery, complications can occur. Pouchitis as the most common long-term complication represents a spectrum of disease processes ranging from acute, antibioticresponsive type to chronic antibiotic-refractory entity. Accurate diagnosis using a combined assessment of symptoms, endoscopy and histology and the stratification of clinical phenotypes is important for treatment and prognosis the disease. The majority of patients respond favorably to antibiotic therapy. However, management of chronic antibiotic-refractory pouchitis remains a challenge.

show abstract

Section: Clinical Presentationsmentioning

confidence: 99%

Pouchitis

Yu¹,

Shao²,

Shen³

2007

WJG

View full text Add to dashboard Cite

show abstract

“…Table 3 depicts the differing definition of anemia and the assessment experiences from different countries. 7,29–34,37–44 …”

Section: Resultsmentioning

confidence: 99%

“…Until recently, iron-deficiency anemia has not been included as a possible long-term complication 31,33,37 after RPC. Iron deficiency anemia is seen in about 6 to 21 percent of patients with functionally acceptable pouches.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and Outcome of Anemia After Restorative Proctocolectomy

M’Koma

Wise

Schwartz

et al. 2009

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

PURPOSE Iron and/or vitamin B12 deficiency anemias, which have adverse effects on patients’ quality of life, are commonly observed and often overlooked complications after restorative proctocolectomy. We performed a systematic review of publications on the prevalence of anemia as well as on the impact of anemia on a range of clinical, functional, quality of life, and economic outcomes in restorative proctocolectomy patients. This information is important to help healthcare providers through a comprehensive overview to increase awareness about a condition that could require therapy to improve patient healthcare and quality of life. METHODS We reviewed the English language publications on the incidence of anemia and its adverse effect after restorative proctocolectomy The United States National Library of Medicine database (MEDLINE), the Excerpta Medica database (EMBASE), the Cochran Library, and the Google® search engine were searched for published articles on the prevalence and impact of anemia in post-restorative proctocolectomy surgical patients. RESULTS The long-term complication most frequently described after RPC is pouchitis. Pouchitis is significantly associated with iron deficiency anemia caused by pouch mucosal bleeding. Other causes are insufficient and/or impaired iron absorption. It has also been observed, however, that restorative proctocolectomy patients with underlying familial adenomatous polyposis rarely develop pouchitis yet show higher rates of iron deficiency anemia compared to those patients with underlying ulcerative colitis. Other causes shown as independent risk factors for iron deficiency anemia in restorative proctocolectomy patients are malignancy, desmoid tumors, and J-pouch configuration. Vitamin B12 deficiency anemia is also common after restorative proctocolectomy. About one-third of restorative proctocolectomy patients show abnormal Schilling test and 5 percent have low referenced serum cobalamin. It has been observed that the degree resection of the terminal-ileum, malabsorption, bacterial overgrowth, and dietary factors are among the known causes of cobalamin deficiency. Folate deficiency has not been reported in restorative proctocolectomy patients. Describing restorative proctocolectomy surgery and its outcomes, in patients without anemia, the quality of life is reported excellent regardless of operative technique. CONCLUSIONS Anemia is not uncommon following restorative proctocolectomy and has been shown to have negative effects on the patient's quality of life and the economy and may substantially increase healthcare costs. The treatment of anemia and its underlying causes is important to improving clinical and economic outcomes.

show abstract

“…Specific symptoms related to active inflammation, such as rectal bleeding, fever and arthralgia, may help identify pouchitis or cuffitis, but symptoms are not exact. For instance, anaemia can be a presenting symptom of pouchitis in otherwise asymptomatic patients [68]. It is therefore good practice to confirm the diagnosis by performing pouchoscopy and pouch biopsies in patients with symptoms suggesting pouchitis, and this is supported by current guidelines [51].…”

Section: The Problematic Pouchmentioning

confidence: 95%

Managing Intractable Proctitis and the Problematic Pouch

Kent

Keshav²

2014

Dig Dis

View full text Add to dashboard Cite

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.

show abstract

Iron-Deficiency Anemia as Presentation of Pouchitis

Abstract: Iron-deficiency anemia may be a clinical presenting sign of pouchitis. Hemoglobin levels may be considered as surveillance tools for pouchitis in patients with IPAA.

Cited by 33 publications

References 11 publications

Pouchitis

Pouchitis

Prevalence and Outcome of Anemia After Restorative Proctocolectomy

Managing Intractable Proctitis and the Problematic Pouch

Contact Info

Product

Resources

About