Patients Undergoing Ileoanal Pouch Surgery Experience a Constellation of Symptoms and Consequences Representing a Unique Syndrome

Cavallaro, Paul; Fearnhead, Nicola; Bissett, Ian; Brar, Mantaj S.; Cataldo, Thomas E.; Clark, David; Denoya, Paula; Elder, Amber L; Gecse, Krisztina; Hendren, Samantha; Holubar, Stefan D.; Jeganathan, Nimalan A; Myrelid, Pär; Norton, Beth-Anne; Wexner, Steven D.; Wilson, L.; Zaghiyan, Karen; Bordeianou, Liliana

doi:10.1097/dcr.0000000000002099

Cited by 10 publications

(25 citation statements)

References 18 publications

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“…Complicating this is the variability in how functional outcomes after IPAA are defined and the lack of standardisation in which symptoms are reported. 7,8 Functional disorders of the pouch include irritable pouch syndrome and pouch evacuation disorders such as dyssynergic defecation of the pouch. 9 Analogous to patients with an intact colon and rectum, impaired pouch evacuation may be driven by paradoxical contraction or inadequate relaxation of pelvic floor muscles (i.e., dyssynergic defecation of the pouch) and/or reduced propulsive forces during attempted defecation.…”

Section: Introductionmentioning

confidence: 99%

Defining normal pouch function in patients with ileal pouch‐anal anastomosis: a pilot study

Quinn

Busciglio

Burton

et al. 2022

Aliment Pharmacol Ther

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Summary Background Most patients experience good functional outcomes following ileal pouch‐anal anastomosis (IPAA) for ulcerative colitis. Aim We aimed to determine if asymptomatic patients with an IPAA had findings consistent with normal defecation on standard objective anorectal tests. Methods Patients 18–65 years old with IPAA and self‐reported healthy pouch function were recruited. Patients with chronic pouchitis, Crohn’s disease, anastomotic stricture, or indication for IPAA other than ulcerative or indeterminate colitis were excluded. Patients underwent an interview with an abbreviated Rome Questionnaire followed by high‐resolution ano‐pouch manometry, balloon expulsion test, pouch barostat, and magnetic resonance (MR) defecography. Results Twenty patients completed all testing. Six patients were excluded from the final analysis due to symptoms suggestive of pouch evacuation disorder on the abbreviated Rome Questionnaire (n = 2), structural abnormality on MR imaging (n = 3), or both (n = 1). Of the remaining 14 patients, mean anal resting pressure during high‐resolution manometry was 72 ± 16 mmHg, mean anal squeeze pressure was 247 ± 69 mmHg, and mean pouch‐anal gradient during the simulated evacuation was −27 ± 37 mmHg. The meantime to balloon expulsion was 54 seconds. During dynamic MR defecography, the mean descent of ano‐pouch junction was 2.6 cm, and mean pouch evacuation was 44.5% and 74.2% pre‐ and posttoilet phase, respectively. Conclusions A substantial proportion of patients with IPAA and self‐reported healthy pouch function have anatomic and/or functional abnormalities of the pouch. In asymptomatic IPAA patients with an anatomically normal pouch, we have proposed normal parameters for high‐resolution ano‐pouch manometry, time to balloon expulsion, pouch barostat, and MR defecography.

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Section: Introductionmentioning

confidence: 99%

Defining normal pouch function in patients with ileal pouch‐anal anastomosis: a pilot study

Quinn

Busciglio

Burton

et al. 2022

Aliment Pharmacol Ther

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“…However, to truly get the whole picture physiology findings also needs to be correlated to specific symptoms. 3 Second, it is difficult to define the healthy pouch. Out of the 25 patients with self-reported normal function only 14 were asymptomatic and/or without abnormalities on MR imaging.…”

Section: N V I T E D E D I T O R I a L Editorial: What Is Normal Func...mentioning

confidence: 99%

“…The study by Quinn et al, 1 makes it obvious that we could—and should—aim for adding objective functional data as physiology and dynamic MR may augment, and complement, self‐reported function scores. However, to truly get the whole picture physiology findings also needs to be correlated to specific symptoms 3 …”

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confidence: 99%

“…This spotlights that previous quantifications of pouch function may have been biased by our perceptions as clinicians. Importantly, based on patient‐reported outcomes after pouch surgery and patient involvement, a Delphi process has recently come up with a consensus definition of an ileoanal pouch syndrome, 3 with an intent to eventually provide a clinically useful scoring for pouch dysfunction.…”

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confidence: 99%

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Editorial: what is normal function of a pelvic pouch?

Myrelid

Söderholm

2022

Aliment Pharmacol Ther

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“…This underscores the importance of asking our patients appropriate questions regarding pouch function and pouch evacuation to identify those patients with suboptimal pouch mechanics 3 . We applaud the development and refinement of specific core symptoms and accommodations relevant to patients with pouches 4 but further work is needed to develop reproducible and responsive methods for these assessments, and hopefully link these to objective measures of pouch function to better guide treatment decisions.…”

mentioning

confidence: 99%