Controlled study using wireless capsule endoscopy for the evaluation of the small intestine in chronic refractory pouchitis.
BACKGROUND
Pouchitis is a common long-term complication after ileal pouch anal anastomosis for ulcerative colitis. Chronic refractory pouchitis is a treatment-resistant condition that affects 5-15% of patients.


OBJECTIVE
To test the hypothesis of a small bowel involvement using wireless capsule endoscopy.


METHODS
This is a single-blind, prospective, cohort study. Twenty-four patients: 16 were patients with chronic refractory pouchitis and eight, with a macroscopically and histologically normal ileal pouch, were considered as control subjects. Diagnosis of pouchitis was confirmed using the pouchitis disease activity index. All subjects were submitted to wireless capsule endoscopy procedure. Within 2 weeks before wireless capsule endoscopy, patients underwent a pouch endoscopy and a small bowel follow-through. Re-examination of the colonic surgical and histological specimens was also performed.


RESULTS
One patient with chronic pouchitis was excluded because of incomplete bowel cleaning. At small bowel follow-through of 16 patients, two subjects (13%) showed only a focal ectasia of the middle ileum and a substenosis of the pouch. At wireless capsule endoscopy all the 15 evaluable patients with chronic pouchitis (100%) showed diffuse lesions from duodenum to ileum consisting of aphthae, erosions, erythema, atrophy, cobblestone, deep/fissural ulcers.


CONCLUSIONS
This enteropathy needs further research, and wireless capsule endoscopy could be useful to show involvement of small bowel in patients with chronic pouchitis.
Calabrese
C
C
Department of Internal Medicine and Gastroenterology, University of Bologna, Policlinico Sant'Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. calabrese.c@med.unibo.it
Fabbri
A
A
Gionchetti
P
P
Rizzello
F
F
Morselli
C
C
Liguori
G
G
Poggioli
G
G
Campieri
M
M
Di Febo
G
G
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D053704:Capsule Endoscopy; D016022:Case-Control Studies; D002908:Chronic Disease; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D019449:Pouchitis / Q000175:diagnosis* / Q000188:drug therapy; D011446:Prospective Studies; D016037:Single-Blind Method
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab