Leukocytapheresis for the treatment of active pouchitis: a pilot study

Araki, Yasumi; Mitsuyama, Keiichi; Nagae, Takaaki; Tou, Yuji; Nakagawa, Motonori; Iwatani, Yasue; Harada, Masakazu; Ozasa, Hiroyuki; Sata, Michio; Noake, Toshihiro

doi:10.1007/s00535-008-2199-0

Cited by 14 publications

(7 citation statements)

References 30 publications

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“…However, the long‐term effectiveness of anti‐TNF‐alpha antibody has not been well studied, and other treatment options are currently being sought. An open‐label study consisting of eight patients only showed possible short‐term effectiveness of cytapheresis for the treatment of pouchitis and no adverse effects were observed in this study. Thus, cytapheresis may be applied to the treatment of pouchitis, although the current evidence is not sufficient to make any concrete conclusions.…”

Section: Management Of Pouchitismentioning

confidence: 61%

Pouchitis after ileal pouch‐anal anastomosis in ulcerative colitis: Diagnosis, management, risk factors, and incidence

Hata

Ishihara

Nozawa

et al. 2016

Digestive Endoscopy

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Restorative proctocolectomy with ileal pouch-anal anastomosis has been the surgical treatment of choice for patients with ulcerative colitis who require surgery. Quality of life after this procedure is satisfactory in most cases; however, pouchitis is a troublesome condition involving inflammation of the ileal pouch. When a patient presents with symptoms of pouchitis, such as increased bowel movements, mucous and/or bloody exudates, abdominal cramps, and fever, endoscopy is essential for a precise diagnosis. The proximal ileum and rectal cuff, as well as the ileal pouch, should be endoscopically observed. The reported incidence of pouchitis ranges from 14% to 59%, and antibiotic therapy is the primary treatment for acute pouchitis. Chronic pouchitis includes antibiotic-dependent and refractory pouchitis. Intensive therapy including antitumor necrosis factor antibodies and steroids may be necessary for antibioticrefractory pouchitis, and pouch failure may occur despite such intensive treatment. Reported risk factors for the development of pouchitis include presence of extraintestinal manifestations, primary sclerosing cholangitis, non-smoking, and postoperative non-steroidal anti-inflammatory drug usage. In the present review, we focus on the diagnosis, endoscopic features, management, incidence, and risk factors of pouchitis in patients with ulcerative colitis who underwent ileal pouch-anal anastomosis.

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Section: Management Of Pouchitismentioning

confidence: 61%

Pouchitis after ileal pouch‐anal anastomosis in ulcerative colitis: Diagnosis, management, risk factors, and incidence

Hata

Ishihara

Nozawa

et al. 2016

Digestive Endoscopy

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“…One study evaluated the efficacy of another type of leukocytapheresis with Cellsorba filter column (LCAP) in active pouchitis [Araki et al 2008]. A total of eight patients received LCAP weekly for 5 weeks along with baseline therapy including an antibiotic (metronidazole), probiotics, 5-ASA or corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of granulocyte and monocyte apheresis for antibiotic-refractory pouchitis after proctocolectomy for ulcerative colitis: an open-label, prospective, multicentre study

Yamamoto

Tanaka

Yokoyama³

et al. 2016

Therap Adv Gastroenterol

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Background:Granulocyte and monocyte apheresis (GMA) has shown therapeutic efficacy in active ulcerative colitis (UC). We thought that in patients with pouchitis after proctocolectomy for UC, GMA might produce immunological effects in the intestinal mucosa, and improve clinical symptoms. This prospective study was to evaluate the efficacy of GMA for antibiotic-refractory pouchitis after proctocolectomy for UC.Methods:A total of 13 patients with pouchitis disease activity index (PDAI) > 7 unresponsive to 2 weeks of antibiotic therapy were included. All patients received 10 GMA sessions at 2 sessions/week over 5 consecutive weeks. The primary endpoints were response (a decrease of ⩾3 points in the PDAI) and remission (PDAI < 4). Secondary endpoints included reduction of white blood cells (WBCs), C-reactive protein (CRP), faecal markers (calprotectin and lactoferrin), reduction of the PDAI endoscopic subscore, and GMA safety.Results:The median PDAI score was significantly decreased from 11 (range, 9–15) at entry to 9 (range, 6–13) after the GMA therapy (p = 0.02). A total of six patients (46%) responded to the treatment, but none achieved remission. The median endoscopic subscore (maximum: 6) was 5 (range, 4–6) at entry and 5 (range, 1–6) after the treatment (p = 0.10). None of the laboratory markers (WBCs, CRP, faecal calprotectin and lactoferrin) significantly changed during the treatment. Transient adverse events (AEs) were observed in two patients (15%), dyspnoea in one and headache in one. The AEs were not serious, and all patients completed the 10 GMA sessions.Conclusions:GMA has a good safety profile, but its efficacy appears to be limited in the management of chronic refractory pouchitis. However, a large controlled study should be conducted to evaluate the efficacy of GMA therapy in patients with pouchitis at an earlier clinical stage, before the disease has become refractory to conventional medical therapy.

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“…Removal of white blood cells from circulation by means of leucocytapheresis has been reported as a potential therapy for patients with active pouchitis 26. Eight patients were treated in an open-label treatment protocol, six of whom achieved remission with no adverse reactions observed.…”

Section: Treatment Of Pouchitismentioning

confidence: 99%

Pouchitis: a practical guide

Steinhart

Ben‐Bassat

2012

Frontline Gastroenterol

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Up to 30% of patients with ulcerative colitis (UC) will require surgical management. The established surgical procedure of choice is colectomy with ileal pouch-anal anastomosis (IPAA) for most patients. Patients with UC who have undergone IPAA are prone to develop inflammatory and non-inflammatory complications. Up to 50% of patients can be expected to experience at least one episode of pouchitis, and most of these patients will experience at least one additional acute episode within 2 years. In other cases, pouchitis might follow a relapsing-remitting course or a chronically active course. The specific aetiology of pouchitis is unknown and the optimal means of diagnosis and classification of pouchitis is not completely agreed upon. Diagnosis of pouchitis based on symptoms alone has been shown to be non-specific due to the fact that symptoms can originate from a myriad of aetiologies, not necessarily inflammatory in nature. As a result, the diagnosis of pouchitis should generally be based on the appropriate constellation of symptoms, combined with endoscopic and histological assessment. Due to the frequently relapsing course of pouchitis, and the fact that the aetiology and pathogenesis are not entirely clear, the long-term management can sometimes be challenging. This review outlines the features suggestive of deviation from 'normal' pouch function and provides an approach to the optimal use of diagnostic modalities and medical therapies to treat pouchitis in its various forms.

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Leukocytapheresis for the treatment of active pouchitis: a pilot study

Abstract: Leukocytapheresis therapy could be a new therapeutic strategy for patients with pouchitis after ileal pouch-anal anastomosis for ulcerative colitis. These encouraging results lead us to propose a randomized controlled trial.

Cited by 14 publications

References 30 publications

Pouchitis after ileal pouch‐anal anastomosis in ulcerative colitis: Diagnosis, management, risk factors, and incidence

Pouchitis after ileal pouch‐anal anastomosis in ulcerative colitis: Diagnosis, management, risk factors, and incidence

Efficacy of granulocyte and monocyte apheresis for antibiotic-refractory pouchitis after proctocolectomy for ulcerative colitis: an open-label, prospective, multicentre study

Pouchitis: a practical guide

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