Pouchitis: extracolonic manifestation of ulcerative colitis?

Teixeira, William Gemio Jacobsen; Silva, José Hyppólito da; Teixeira, Magaly Gêmio; Almeida, Maristela Gomes de; Calache, João Elias; Habr‐Gama, Angelita

doi:10.1590/s0041-87811999000500005

Cited by 19 publications

(12 citation statements)

References 25 publications

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“…Unfortunately, some patients with treatment‐unresponsive pouchitis may develop clinical and pathological complications that closely mimic CD. These include proximal strictures, pouch stenosis or fistulas, perianal fissures or fistulas, and even some extraintestinal manifestations of IBD, such as iridocyclitis, arthritis and pyoderma gangrenosum 22,196,202,207,214,216,227,228,230–233 . In these settings, pathologists may be tempted to question the validity of their original diagnosis (presumably UC) and entertain the possibility of CD instead.…”

Section: Pouchitismentioning

confidence: 99%

Diagnostic difficulties in inflammatory bowel disease pathology

2005

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This review summarizes some of the common diagnostic problems encountered by pathologists when evaluating patients with chronic colitis and in whom inflammatory bowel disease (IBD) is either suspected or within the differential diagnosis. Both ulcerative colitis (UC) and Crohn's disease (CD) show characteristic, but non-specific, pathological features that may overlap and result in a diagnosis of 'indeterminate colitis' (IC). However, other reasons why pathologists may entertain a diagnosis of IC include failure to recognize or accept certain 'hardcore' histological features as indicative of CD, an attempt to classify cases of chronic colitis based on mucosal biopsy material or in the absence of adequate clinical and radiographic information, and the presence of other disease processes that mask, or mimic, IBD. In addition, some cases of UC may show unusual CD-like features, such as discontinuous or patchy disease, ileal inflammation, extracolonic inflammation, granulomatous inflammation in response to ruptured crypts, aphthous ulcers, or transmural inflammation. Furthermore, other forms of colitis, such as microscopic colitis, diverticulitis and diversion colitis may, on occasion, also show IBD-like changes. The clinical and pathological features that aid in the distinction between these entities, and others, are covered in detail in this review.

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Section: Pouchitismentioning

confidence: 99%

Diagnostic difficulties in inflammatory bowel disease pathology

2005

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“…In particular, pouchitis occurs almost exclusively in patients who underwent IPAA for UC, rather than for FAP (7,12,13), which suggests an autoimmune etiology for this condition in genetically predisposed individuals. Other factors in support of this theory include the existence of extra-intestinal events associated with an increased risk of developing pouchitis (3,9,14) and the endoscopic and histopathological similarities observed between patients with pouchitis and those with UC (15,16). …”

Section: Introductionmentioning

confidence: 97%

“…There is also an increased risk for the development of pouchitis in female patients (6) and in those with extensive or severe UC (7), extra-intestinal manifestations (3,9,14), early disease onset (3), the use of non-steroidal anti-inflammatory drugs (10), gene polymorphisms in the interleukin-1 receptor and TNF-1 antagonists (11) and the presence of perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) (17). Additionally, colonic metaplasia is a common histopathological finding for the ileal pouch and is observed in approximately 50% of patients with pouchitis and approximately 18% of patients undergoing IPAA without pouchitis (18).…”

Section: Introductionmentioning

confidence: 99%

Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis

Arashiro

Teixeira

Rawet³

et al. 2012

Clinics

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OBJECTIVE:Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. Additionally, one rare but potential complication is the development of adenocarcinoma of the reservoir. The aim of this study was to evaluate the most frequently observed histopathological changes in ileal pouches and to correlate these changes with potential risk factors for complications.METHODS:A total of 41 patients were enrolled in the study and divided into the following three groups: a non-pouchitis group (group 1) (n = 20; 8 males; mean age: 47.5 years) demonstrating optimal outcome; a pouchitis without antibiotics group (group 2) (n = 14; 4 males; mean age: 47 years), containing individuals with pouchitis who did not receive treatment with antibiotics; and a pouchitis plus antibiotics group (group 3) (n = 7; 3 males; mean age: 41 years), containing those patients with pouchitis who were administered antibiotics. Ileal pouch endoscopy was performed, and tissue biopsy samples were collected for histopathological analysis.RESULTS:Colonic metaplasia was found in 15 (36.6%) of the 41 patients evaluated; of these, five (25%) were from group 1, eight (57.1%) were from group 2, and two (28.6%) were from group 3. However, no correlation was established between the presence of metaplasia and pouchitis (p = 0.17). and no differences in mucosal atrophy or the degree of chronic or acute inflammation were observed between groups 1, 2, and 3 (p>0.45). Moreover, no dysplasia or neoplastic changes were detected. However, the degree of mucosal atrophy correlated well with the time of postoperative follow-up (p = 0.05).CONCLUSIONS:The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.

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“…21 A number of theories have been proposed, including fecal stasis, 22 bacterial overgrowth, 23 and recurrent IBD. 24,25 One interesting theory is based on a vascular cause. 26 Experimental animal evidence indicates that induced microvascular thrombosis causes an entity similar to Crohn's disease, and hence, to pouchitis.…”

Section: Introductionmentioning

confidence: 99%