title: Comprehensive evaluation of inflammatory and noninflammatory sequelae of ileal pouch-anal anastomoses.
abstract: 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.
authors.affiliation: Center for Inflammatory Bowel Disease, Departments of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.forename: Ana E
authors.initials: AE
authors.lastname: Bennett
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Achkar
authors.forename: Aaron
authors.initials: A
authors.lastname: Brzezinski
authors.forename: Farah
authors.initials: F
authors.lastname: Khandwala
authors.forename: Wendy
authors.initials: W
authors.lastname: Liu
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Bambrick
authors.forename: Jane
authors.initials: J
authors.lastname: Bast
authors.forename: Bret
authors.initials: B
authors.lastname: Lashner
mesh_terms: 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