Incidence and short-term implications of prepouch ileitis following restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis.
OBJECTIVE
Pouchitis following restorative proctocolectomy is common. Inflammation proximal to the pouch, prepouch ileitis (PPI) has recently been described. Its incidence and implications are unknown. The aim of this study was to identify the incidence of PPI at pouchoscopy and correlate this with symptoms, diagnosis, and outcome.


METHODS
The authors searched the endoscopy database at our institution for the terms "pouchitis" and "ileitis" and reviewed hospital records.


RESULTS
A total of 1448 pouchoscopies were performed on 742 patients. PPI was diagnosed in 34 (5.7 percent) patients with ulcerative colitis/indeterminate colitis and 1 (0.6 percent) with polyposis. All of the patients had concurrent pouch inflammation, and in this group the incidence was 13 percent. The median length of the PPI was 10 cm. Asymptomatic patients totaled 26 percent. At follow-up (median, 12 months) no patient was reclassified to Crohn's disease, and no patients required an ileostomy for poor function.


CONCLUSIONS
The incidence of PPI in patients with ulcerative colitis/indeterminate colitis is 5.7 percent, and it occurs in 13 percent of patients with pouch inflammation. All of the patients had associated pouch inflammation; however, not all of the patients were symptomatic. Our results demonstrate that PPI is common in patients with pouchitis; it does not imply missed Crohn's disease or predict an increased rate of pouch failure, at least in the short term.
McLaughlin
Simon D
SD
Department of Biosurgery and Surgical Technology, Imperial College, London, United Kingdom. simon.mclaughlin@nhs.net
Clark
Susan K
SK
Bell
Andrew J
AJ
Tekkis
Paris P
PP
Ciclitira
Paul J
PJ
Nicholls
R John
RJ
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D019819:Budesonide / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007079:Ileitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D015994:Incidence; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D019449:Pouchitis / Q000453:epidemiology / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D011446:Prospective Studies; D012189:Retrospective Studies
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D008795:Metronidazole; D019804:Mesalamine; D019819:Budesonide; D002939:Ciprofloxacin