Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis.
BACKGROUND
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice in the majority of patients with ulcerative colitis (UC) who require surgery. To ease the construction of the IPAA and improve functional outcome by minimizing sphincter related stretch injury, a stapling technique is being commonly used in the pouch-anal anastomosis. Despite its advantages, the procedure normally leaves a 1-2 cm of anal transitional zone or rectal cuff, which is susceptible to recurrence of residual UC or cuffitis. Cuffitis can cause symptoms mimicking pouchitis.


OBJECTIVE
To conduct an open-labeled trial of topical mesalamine in patients with cuffitis.


METHODS
We treated 14 consecutive patients with cuffitis by giving mesalamine suppositories 500 mg b.i.d. (mean 3.2 months, range 1-9 months). The Cuffitis Activity Index (adapted from the Pouchitis Disease Activity Index) scores and improvement in symptoms of bloody bowel movements and arthralgias were measured as primary and secondary outcomes.


RESULTS
All patients had surgery for medically refractory UC. There were significant reductions in the total Cuffitis Activity Index scores after the therapy (11.93 +/- 3.17 vs 6.21 +/- 3.19, p < 0.001). Symptom (3.24 +/- 1.28 vs 1.79 +/- 1.31), endoscopy (3.14 +/- 1.29 vs 1.00 +/- 1.52), and histology (4.93 +/- 1.77 vs 3.57 +/- 1.39) scores each were significantly reduced (p < 0.05). Ninety-two percent of patients with bloody bowel movements and 70% of patients with arthralgias improved after the therapy. No systemic or topical adverse effects were reported.


CONCLUSIONS
Topical mesalamine appears well tolerated and effective in treating patients with cuffitis, with improvement in symptom as well as endoscopic and histologic inflammation.
Center for Inflammatory Bowel Disease, Departments of Gastroenterology/Hepatology, Anatomic Pathology, and Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Bo
B
Shen
Bret A
BA
Lashner
Ana E
AE
Bennett
Feza H
FH
Remzi
Aaron
A
Brzezinski
Jean-Paul
JP
Achkar
Jane
J
Bast
Marlene L
ML
Bambrick
Victor W
VW
Fazio
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012007:Rectum / Q000473:pathology* / Q000601:surgery; D013488:Suppositories; D017792:Surgical Stapling / Q000009:adverse effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D019804:Mesalamine