Comprehensive evaluation of inflammatory and noninflammatory sequelae of ileal pouch-anal anastomoses.
OBJECTIVE
Ileal pouch-anal anastomosis (IPAA) improves quality of life (QOL) for ulcerative colitis patients who require surgery. Crohn's disease (CD) of the pouch, pouchitis, cuffitis, and irritable pouch syndrome (IPS) have an adverse impact on physical and psychological well-being, which can compromise the gain in QOL after the surgery. Their clinical, endoscopic, and histologic features have not been fully characterized. The aim of this study was to compare demographic, clinical, endoscopic, and histologic features between CD of the pouch, pouchitis, cuffitis, IPS, and normal pouches. METHODS We enrolled 124 patients: normal pouches (N = 26), CD of the pouch (N = 23), pouchitis (N = 22), cuffitis (N = 21), and IPS (N = 32). Symptomatology, endoscopy, histology, and the Cleveland Global QOL and the Irritable Bowel Syndrome-QOL scores were compared among the groups.


RESULTS
Univariate analysis of demographic and clinical data showed a possible association between NSAID use and pouchitis, extraintestinal manifestation and cuffitis, and antidepressant use and IPS. There were no differences in the Pouchitis Disease Activity Index symptom scores between the disease groups, with an exception of bleeding, which occurred almost exclusively in cuffitis. Endoscopy was useful in discriminating between CD of the pouch, pouchitis, cuffitis, and normal pouches or IPS. Patients with diseased IPAA had worse QOL scores.


CONCLUSIONS
Symptoms largely overlapped among the disease groups of IPAA. Endoscopy is valuable for diagnosis. Inflammatory or noninflammatory sequelae of IPAA adversely affected patients' QOL.
Shen
Bo
B
Center for Inflammatory Bowel Disease, Departments of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio.
Fazio
Victor W
VW
Remzi
Feza H
FH
Delaney
Conor P
CP
Bennett
Ana E
AE
Achkar
Jean-Paul
JP
Brzezinski
Aaron
A
Khandwala
Farah
F
Liu
Wendy
W
Bambrick
Marlene L
ML
Bast
Jane
J
Lashner
Bret
B
D000328:Adult; D039021:Colonic Pouches / Q000009:adverse effects*; D003424:Crohn Disease / Q000209:etiology / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000209:etiology / Q000473:pathology*; D011788:Quality of Life