Su1658 Incidence and Severity of Pre-Pouch Ileitis: a Distinct Disease Entity or a Manifestation of Refractory Pouchitis?

Samaan, Mark A; Jong, Djuna C. de; Sahami, Saloomeh; Morgan, Stephen J.; Fragkos, Konstantinos C.; Subramaniam, Sharmila; Kok, Klaartje; Makanyanga, Jesica; Barnova, I; Saravanapavan, Hajeena; Parisi, Ioanna; Di, Simona; Rahman, Farooq; Bloom, Stuart; Brink, Gijs R. van den; Löwenberg, Mark; Ponsioen, Cyriel; Buskens, Christianne J.; Tanis, Pieter J.; Overstraeten, Anthony de Buck van; D’Hoore, André; Bemelman, Willem A.; D’Haens, Geert R.

doi:10.1016/j.gie.2015.03.1506

Cited by 8 publications

(15 citation statements)

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“…According to recent data, including a multicenter study, the incidence of prepouch ileitis is about 4% to 6% of all patients who underwent IPAA surgery. 115 , 116 Practically all patients with prepouch ileitis have simultaneous pouchitis, suggesting a likely related etiology. However, prepouch ileitis is more frequently refractory to antibiotic therapy compared with pouchitis; thus, immunomodulatory therapy is more often required.…”

Section: Ulcerative Colitismentioning

confidence: 99%

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Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls

Kővári

Pai

2021

Advances in Anatomic Pathology

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The upper gastrointestinal (UGI) manifestations of inflammatory bowel diseases (IBDs) are frequently obscured by classic ileal and colonic symptoms and are reported to involve only 0.5% to 4% of adult patients. However, because of the improvement of endoscopic techniques and the growing use of esophagogastroduodenososcopy with biopsy, both asymptomatic and clinically significant esophageal, gastric, and duodenal manifestations are increasingly recognized. The UGI involvement in IBD was historically synonymous with Crohn’s disease (CD), but the doctrine of ulcerative colitis (UC) being limited to the colon has been challenged, and UC-related gastroduodenal lesions have been reported. The diagnosis of UGI IBD should ideally rely on a combination of the clinical history, endoscopic picture, and histologic features. Although endoscopic changes such as aphthoid or longitudinal ulcers and bamboo-joint-like pattern are suggestive of CD, histologic evaluation increases the sensitivity of the IBD diagnosis since histologic alterations may be present in endoscopically unremarkable mucosa. Conversely, in many cases, the histologic findings are nonspecific, and the knowledge of clinical history is vital for reaching an accurate diagnosis. The presence of epithelioid granuloma is highly suggestive of CD but is present in a minority of CD cases; thus, pathologists should be aware of how to diagnose UGI IBD in the absence of granulomata. This article reviews the most important clinical, endoscopic, and histologic features of IBD-associated esophagitis, gastritis, and duodenitis, as well as the IBD-related manifestations in the biliary tract and the postcolectomy setting.

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Section: Ulcerative Colitismentioning

confidence: 99%

“…However, prepouch ileitis is more frequently refractory to antibiotic therapy compared with pouchitis; thus, immunomodulatory therapy is more often required. 116 …”

Section: Ulcerative Colitismentioning

confidence: 99%

Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls

Kővári

Pai

2021

Advances in Anatomic Pathology

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“…Prepouch ileitis affects 6% of patients with IPAA [55] and usually occurs with primary idiopathic pouchitis [55–57]. It presents with similar symptoms to pouchitis.…”

Section: Causes Of the Pouch Behaving Badlymentioning

confidence: 99%

The pouch behaving badly: management of morbidity after ileal pouch–anal anastomosis

et al. 2021

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Aim Ileal pouch–anal anastomosis (IPAA), or a ‘pouch’, allows restoration of intestinal continuity after proctocolectomy for ulcerative colitis or familial adenomatous polyposis. Most patients have a good long‐term outcome after IPAA, but in a significant proportion the functional outcome and quality of life are unsatisfactory. We term this outcome ‘the pouch behaving badly’. Managing this, especially one is when unfamiliar with the possible underlying pathologies, is a challenge for both patient and clinician. We aim to outline the clinical approach to the pouch behaving badly, highlighting key aspects of investigation and management. Method This is a narrative review of the literature covering the investigation and management of postoperative complications and morbidity after IPAA. Results Management of the pouch behaving badly requires a careful clinical assessment. The patient may present with multiple symptoms and a clear picture of the symptomatology and past history should be constructed before thorough examination and specialist investigation. We divide the pathology that underlies this clinical scenario into surgical, inflammatory, mechanical, functional and dysplastic causes and outline the investigation and management of each one. Conclusion The pouch behaving badly is a challenging problem for both patient and clinician. A detailed clinical assessment with careful specialist investigation is key to diagnosing the underlying pathology. We stress the importance of patient‐centred care – the aim is to improve quality of life.

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“…[6][7][8] We also agree that there is no single distinguishing feature to differentiate between pouchitis, Crohn's of the pouch, or backwash ileitis; however, when combined, some features can lead us to a pragmatic approach for diagnosis. The development of fistulising or a long segment of proximal small bowel disease is synonymous with Crohn's disease of the pouch whereas inflammation located solely in the pouch body with no histologic elements of other entities (ie, absence of granulomas), the presence of inflammation in the afferent limb, 9 and absence of deep ulcers point towards classical pouchitis.…”

Section: N V I T E D E D I T O R I a Lmentioning

confidence: 99%

Editorial: standardising inclusion and outcome criteria for pouchitis—a fragile consensus perhaps but a first step in the right direction. Authors' reply

Sedaño

Jairath

2021

Aliment Pharmacol Ther

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Su1658 Incidence and Severity of Pre-Pouch Ileitis: a Distinct Disease Entity or a Manifestation of Refractory Pouchitis?

Cited by 8 publications

References 0 publications

Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls

Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls

The pouch behaving badly: management of morbidity after ileal pouch–anal anastomosis

Editorial: standardising inclusion and outcome criteria for pouchitis—a fragile consensus perhaps but a first step in the right direction. Authors' reply

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