Results of pouch surgery after ileo‐anal anastomosis: The implications of pouchitis

Fozard, Basil; Pembérton, John H.

doi:10.1007/bf02066985

Cited by 23 publications

(10 citation statements)

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“…"Pouch ileitis" was first described by Kock The frequency of occurrence of pouchitis is estimated to be as high as 50%2,3 in ileoanal continent reservoirs and 43% in Kock pouches. "4 However, there is wide variability of reporting in the literature, which may be due to a lack of [5][6][7][8] accepted diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Terminal Ileal and Colonic Resection Histopathology Predicts Risk of Pouchitis in Patients After Ileoanal Pull-Through Procedure

Schmidt¹,

Lazenby²,

Hendrickson³

et al. 1998

Annals of Surgery

145

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ObjectiveThis study seeks to compare the histopathology of preoperative terminal ileal and colonic resection specimens with pouch biopsies after the ileoanal pull-through (IAPT) procedure. Summary Background DataPouchitis is the most frequent complication of transanal continent reservoirs in patients after IAPT. MethodsThe authors conducted 751 consecutive pouch biopsies on 73 patients with inflammatory bowel disease or familial adenomatous polyposis who underwent IAPT by a single surgeon over a 1 0-year period. In this preliminary report, a pathologist, in blinded fashion, has graded 468 of the IAPT pouch biopsies and 67 of the patients' preoperative terminal ileal and colonic resection histopathology to date. Colonic histopathology was graded by the extent and severity of disease, terminal ileal and pouch histopathology by active inflammation, chronic inflammation, lymphocyte aggregates, intraepithelial lymphocytes, eosinophils, and villous blunting.

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Section: Discussionmentioning

confidence: 99%

Preoperative Terminal Ileal and Colonic Resection Histopathology Predicts Risk of Pouchitis in Patients After Ileoanal Pull-Through Procedure

Schmidt¹,

Lazenby²,

Hendrickson³

et al. 1998

Annals of Surgery

145

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“…It has been suggested that pouchitis is the result of bacterial overgrowth, particu larly of anaerobic bacteria, secondary to stasis in the ileal pouch (53)(54)(55)(56). The generally satisfactory response to treatment with metronidazole supports this hypothesis.…”

Section: Pouchitismentioning

confidence: 94%

Clinical and Physiological Aspects of Ileal Pouch-Anal Anastomosis

Salemans

Nagengast

1995

Scandinavian Journal of Gastroenterology

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Salemans JMJI, Nagengast FM. Clinical and physiological aspects of ileal pouch-anal anastomosis. Scand J Gastroenterol 1995;30 Suppl 212:3-12.Proctocolectom y with ileal pouch-anal anastomosis is the surgical treatment of choice for severe chronic ulcerative colitis and familial polyposis coli because the entire colonic mucosa is removed while anal function can be preserved and the necessity for permanent ileostomy is eliminated. Long-term functional results are generally gratifying, as defecation frequency and degree of incontinence are acceptable in most patients. Pouchitis, however, a non-specific inflammation of the ileal reservoir, is a major long-term complication occurring in a considerable number o f patients. The etiology of pouchitis is unknown. Since pouchitis occurs more frequently or even exclusively in ulcerative colitis patients it is assumed that pouchitis is a novel manifestation o f inflammatory bowel disease. However, bacterial overgrowth in the ileal pouch may also play a pathogenetic role. Chronic inflammation and villous atrophy o f varying severity is found in virtually all pouches. Acute inflammatory changes and ulceration are associated with pouchitis.

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“…According to Fozard and Pemberton the majority of patients respond rapidly to a short course of treatment. 28 In their series only 3% of the patients were refractory to this therapy or had severe side effects. O'Connell reported that all his patients with pouchitis obtained prompt relief of symptoms.…”

Section: Treatmentmentioning

confidence: 97%

“…Although pouchitis has been reported to occur before ileostomy closure, this complication is seen predominantly after ileostomy closure . 28 Another intriguing observation is that pouchitis appears confined to patients operate d on for ulce rative colitis, whether the pouch is placed in the pelvis or constructe d as a continent ileostomy. 34 However, in 1990 Kmiot et al 35 reported a fully documented case of pouchitis in a patient following ileal reservoir construction for familial adenomatous polyposis.…”

Section: Historymentioning

confidence: 99%

“…21 Although pouchitis occurs both early and late following reservoir construc tion, most patients develop their first episode within 2 years postoperatively. 22,28 Approximately half of the patients have only one single episode, whereas the others present tw o or more episodes. 22,24 Rauh et a l. 24 reported a preponderance of indeterminate colitis in patients with recurre nt episodes of pouchitis.…”

Section: Historymentioning

confidence: 99%

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Pouchitis

Schouten¹

1998

Mediators of Inflammation

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Pouchitis is a major long-term complication of the continent ileostomy as well as the ileoanal pouch anastomosis. When diagnosed on the basis of clinical, endoscopic and histologic features, this syndrome has been demonstrated almost exclusively in patients with ulcerative colitis. The clinical course, the endoscopic findings and the histologic abnormalities resemble those of ulcerative colitis. The association with extra-intestinal manifestations further supports the hypothesis that pouchitis represents ulcerative colitis in the small bowel. All ileal reservoirs show bacterial overgrowth, especially of anaerobes. As a response to this altered intraluminal environment chronic inflammation and incomplete colonic metaplasia occur. The efficiency of metronidazole does suggest that bacteriological factors play an important role in the pathogenesis of pouchitis.

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Results of pouch surgery after ileo‐anal anastomosis: The implications of pouchitis

Cited by 23 publications

References 42 publications

Preoperative Terminal Ileal and Colonic Resection Histopathology Predicts Risk of Pouchitis in Patients After Ileoanal Pull-Through Procedure

Preoperative Terminal Ileal and Colonic Resection Histopathology Predicts Risk of Pouchitis in Patients After Ileoanal Pull-Through Procedure

Clinical and Physiological Aspects of Ileal Pouch-Anal Anastomosis

Pouchitis

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