title: Irritable pouch syndrome: a new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis.
abstract: OBJECTIVE
  Pouchitis often is diagnosed based on symptoms alone. However, increased stool frequency, urgency, and abdominal pain could be due to a condition resembling irritable bowel syndrome. This study was designed to assess the etiology of bowel symptoms using the Pouchitis Disease Activity Index (PDAI).
  
  
  METHODS
  Symptoms, endoscopy, and histology were assessed in 61 consecutive symptomatic patients with ulcerative colitis after ileal pouch-anal anastomosis. Pouchitis was defined as a PDAI score of > or = 7, cuffitis was defined as endoscopic and histological inflammation of the rectal cuff and no inflammation of the pouch, and irritable pouch syndrome (IPS) was defined as symptoms with a PDAI of <7 and the absence of cuffitis.
  
  
  RESULTS
  Thirty-one patients (50.8%) had pouchitis, four (6.5%) had cuffitis, and 26 (42.6%) had IPS. Demographics were similar in the three groups. Increased stool frequency, urgency, and abdominal cramps were the most common symptoms in the three groups. Rectal bleeding was seen only in cuffitis (p < 0.001). No patient in the three groups had fever. Twenty-seven patients (87.1%) with pouchitis responded to a 2-wk course of ciprofloxacin or metronidazole with a reduction in PDAI scores of > or = 3. All four patients with cuffitis responded to topical hydrocortisone or mesalamine with a reduction in the PDAI symptom component score of > or = 1. Twelve patients with IPS (46.2%) responded to antidiarrheal, anticholinergic, and/or antidepressant therapies with a reduction in the PDAI symptom component score of > or = 1, whereas the remaining patients had persistent symptoms despite therapy.
  
  
  CONCLUSIONS
  A substantial number of symptomatic patients after ileal pouch-anal anastomosis do not meet the diagnostic criteria for either pouchitis or cuffitis and have been classified as having IPS. There is an overlap of symptoms among patients with pouchitis, cuffitis, and IPS, and endoscopic evaluation can differentiate among these groups. Distinction between these three groups has therapeutic implications.
authors: Department of Gastroenterology, The Cleveland Clinic Foundation, Ohio 44195, USA.
authors: Bo
authors: B
authors: Shen
authors: Jean-Paul
authors: JP
authors: Achkar
authors: Bret A
authors: BA
authors: Lashner
authors: Adrian H
authors: AH
authors: Ormsby
authors: Aaron
authors: A
authors: Brzezinski
authors: Edy E
authors: EE
authors: Soffer
authors: Feza H
authors: FH
authors: Remzi
authors: Charles L
authors: CL
authors: Bevins
authors: Victor W
authors: VW
authors: Fazio
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003109:Colonic Diseases, Functional / Q000209:etiology / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000209:etiology / Q000473:pathology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D013577:Syndrome