title: Incidence and characteristics of pouchitis in the Kock continent ileostomy and the pelvic pouch.
abstract: The incidence, the median time to first appearance, and the clinical pattern of pouchitis were prospectively studied in 180 patients operated on for ulcerative proctocolitis with a continent ileostomy (CI; 84 patients) and a pelvic pouch (PP; 96 patients). Median follow-up for CI patients was 8.5 years (range, 2-15 years) and for PP patients, 5 years (range, 1-8 years). Pouchitis, with symptoms severe enough to require treatment, developed in 33% (28 of 84) of CI and 47% (45 of 96) of PP patients. The cumulative risk of developing one or more episodes of pouchitis over a 5-year follow-up was 34% in CI patients and 51% in PP patients. The median time to first appearance of pouchitis was 5 and 12 months, respectively. Eighty-six per cent of CI patients with pouchitis (24 of 28) and 71% of PP patients (32 of 45) experienced their initial episode within the first 2 years. Sixty-four per cent (18 of 28) of the CI patients and 76% (34 of 45) of PP patients had one single or a few short-lasting episodes of pouchitis with various symptom-free intervals, whereas 18% of patients in each group (5 of 28 CI patients, 8 of 45 PP patients) had frequent relapses. Most of these patients responded promptly to metronidazole treatment. Eighteen per cent (5 of 28) of CI patients and 6% (3 of 45) of PP patients had long-lasting episodes with a poor response to treatment. In this long-term study the pouch inflammation proved eventually to be Crohn's disease in four patients (2.2%).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Dept. of Surgery II, Sahlgrenska sjukhuset, University of Göteborg, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Svaninger
authors.forename: S
authors.initials: S
authors.lastname: Nordgren
authors.forename: T
authors.initials: T
authors.lastname: Oresland
authors.forename: L
authors.initials: L
authors.lastname: Hultén
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000188:drug therapy / Q000453:epidemiology*; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology*; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D008795:Metronidazole