Pouchitis in inflammatory bowel disease: a review of diagnosis, prognosis, and treatment

Akiyama, Shintaro; Rai, Victoria; Rubin, David T.

doi:10.5217/ir.2020.00047

Cited by 27 publications

(21 citation statements)

References 92 publications

(147 reference statements)

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“…Eleven studies employed NLR as a potential tool to predict post-surgical hospital stay or development of various complications in CD [ 84 , 98 , 99 , 100 , 101 ], UC [ 93 , 102 , 103 , 104 , 105 ], or IBD [ 106 , 107 ].…”

Section: Resultsmentioning

confidence: 99%

“…In a subset of patients with UC who underwent IPAA, Fleshner et al [ 105 ] determined that higher NLR was associated with increased rates of de novo CD as a defined post-surgical complication ( p = 0.03). In patients treated with IFX salvage for steroid-refractory acute severe UC, Con et al [ 103 ] reported a weak but significant correlation between day 3 NLR and colectomy within twelve months ( p = 0.020); NLR value upon admission and on day 1 were not associated with subsequent colectomy ( p = 0.340 and 0.792, respectively). Similarly, Andrew et al [ 93 ] did not find a correlation between NLR and colectomy after hospital admission prior to or one day following IFX salvage therapy (r = −0.01 and −0.01, respectively; correlation method not specified).…”

Section: Resultsmentioning

confidence: 99%

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Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

Langley

Guedry

Goldenberg

et al. 2021

JCM

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Neutrophil–lymphocyte ratio (NLR) is a biomarker of the systemic inflammatory response. The objective of this systematic scoping review was to examine the literature on NLR and inflammatory bowel disease (IBD). PubMed, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, Cochrane Specialized Register, DOAJ, PDQT, Biosis Citation Index, Scopus, and Web of Science were systematically searched. A total of 2621 citations yielding 62 primary studies were synthesized under four categories: distinguishing patients with IBD from controls, disease activity differentiation, clinical outcome prediction, and association of NLR with other IBD biomarkers. Thirty-eight studies employed receiver operating characteristic (ROC) curve analysis to generate optimal NLR cutpoints for applications including disease activity differentiation and prediction of response to treatment. Among the most promising findings, NLR may have utility for clinical and endoscopic disease activity differentiation and prediction of loss of response to infliximab (IFX). Overall findings suggest NLR may be a promising IBD biomarker. Assessment of NLR is non-invasive, low cost, and widely accessible given NLR is easily calculated from blood count data routinely and serially monitored in patients with IBD. Further research is justified to elucidate how evaluation of NLR in research and clinical practice would directly impact the quality and cost of care for patients living with IBD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

Langley

Guedry

Goldenberg

et al. 2021

JCM

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“…In a meta-analysis, the positive predictive value of LGD for concurrent CRC at colectomy was 25.5% and this supported proctocolectomy as a standard treatment of dysplasia in UC [19]. However, proctocolectomy carries high risk of post-operative complications [20]. Ileal pouch anal anastomosis (IPAA) provides chance to save the anus of the patients who underwent proctocolectomy [21,22], and IPAA was possible 89% of UC patients in a Korean multicenter retrospective analysis [23].…”

Section: Surgical Treatment Of Dysplasia In Ucmentioning

confidence: 90%

Recent Advance in the Management of Dysplasia in the Ulcerative Colitis

Yang

2021

JDCR

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Patients having long-standing ulcerative colitis (UC) and Crohn's colitis are exposed to the increased risk of colorectal cancer (CRC) [1-3]. Dysplasia, a precancerous lesion of CRC in the patients having long-standing inflammatory bowel disease (IBD), can be categorized into indefinite for dysplasia (IND), low-grade dysplasia (LGD), and high-grade dysplasia (HGD) [4]. Traditionally, total proctocolectomy had been regarded as a standard treatment not only for CRC but also for dysplasia in UC patients [4]. However, since early studies about the feasibility of polypectomy for dysplasia [5,6], subsequent studies have supported endoscopic resection of polypoid dysplasia could be the first choice for the prevention of CRC in IBD, mostly UC patients. The pooled incidence of CRC after endoscopic resection of polypoid dysplasia is 5.3 cases per 1,000 patient-years in the colitic patients [7], and the incidence of post-colonoscopy CRC was 2 cases per 1,000 patient-years according to a recent metaanalysis regarding outcomes after endoscopic resection of dysplasia in colitic patients [8]. Therefore, recent guidelines suggest that endoscopic resection as a key modality for the treatment of visible and endoscopically resectable dysplasia in the colitic patients [9-11]. HISTOLOGIC FEATURES OF DYSPLASIA IN UC By definition, dysplasia is histologically unequivocal neoplastic epithelium without evidence of tissue invasion and can be categorized as followings: negative for dysplasia, indefinite for dysplasia, and positive for dysplasia [12]. IND is applied to epithelial changes showing extraordinary regeneration but not sufficient for an unequivocal diagnosis of dysplasia. Positive for dysplasia can be subdivided into LGD and HGD. Colitis-associated dysplasia frequently shows his-JDCR

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“…In UC, the approach often involves a restorative proctocolectomy with IPAA due to medically refractory conditions or development of neoplasia. 2 The IPAA is created to avoid a permanent ostomy and to provide patients with an improved quality of life, but it has a well-described risk of acute and chronic complications.…”

Section: S78mentioning

confidence: 99%

Diagnostic and Management Considerations for the IPAA With Crohn’s Disease-Like Features

Akiyama

Dyer

Rubin

2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Patients with ulcerative colitis often develop medically refractory colonic inflammation or colorectal neoplasia, and approximately 10% to 15% of patients require surgery. The most common surgical procedure is a restorative proctocolectomy with IPAA. Even if the preoperative diagnosis is ulcerative colitis, approximately 10% of patients can develop inflammatory pouch conditions resembling a Crohn’s disease phenotype. OBJECTIVE: This study aimed to review the diagnostic approach, prognosis, and management of IPAA with Crohn's disease–like features. DATA SOURCES: The data sources include search in electronic databases. STUDY SELECTION: This narrative review included studies focusing on pouches with Crohn's disease–like features. MAIN OUTCOME MEASURES: The main topics in this review included the pathogenesis, risk factors, diagnosis, phenotypes, prognosis, and medications of pouches with Crohn's disease–like features. RESULTS: A diagnostic approach for the pouch conditions resembling a Crohn's disease phenotype should be based on history–taking to evaluate its risk factors and endoscopic assessment of the pouch. Prior disease history and pathology, location of pouch complications, and timing of complications offer clues for the differential diagnosis of this phenotype. We advocate for the more descriptive term “pouch with Crohn's disease–like features” and reserve the term “Crohn's disease of the pouch” for patients who undergo IPAA and have a precolectomy diagnosis of Crohn's disease or whose colectomy pathology revealed Crohn's disease. Medications, which are often used for traditional Crohn's disease, show efficacy in pouches with Crohn's disease–like features as well. The poor prognosis associated with pouches with Crohn's disease–like features, particularly the fistulizing phenotype, underscores the importance of proactive monitoring and therapeutic intervention. LIMITATIONS: The limitations include no explicit criteria for article selection. CONCLUSIONS: This review suggests future research should seek to understand the natural history and meaningful shorter and longer term therapeutic targets for these types of pouch phenotypes. Long-term follow-up and prospective preoperative and postoperative interventional trials of treatments and prevention strategies are needed.

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Pouchitis in inflammatory bowel disease: a review of diagnosis, prognosis, and treatment

Cited by 27 publications

References 92 publications

Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review

Recent Advance in the Management of Dysplasia in the Ulcerative Colitis

Diagnostic and Management Considerations for the IPAA With Crohn’s Disease-Like Features

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