title: Backwash ileitis does not affect pouch outcome in patients with ulcerative colitis with restorative proctocolectomy.
abstract: OBJECTIVE
  There has been controversy over the significance of active inflammation of the terminal ileum (also known as backwash ileitis) in patients with ulcerative colitis (UC) and idiopathic inflammatory bowel disease of indeterminate type for diagnosis and pouch construction. We investigated the impact of backwash ileitis on pouch outcome after restorative proctocolectomy with ileoanal pouch anastomosis.
  
  
  METHODS
  Data from patients with backwash ileitis (n = 132) were compared with those from 132 matched controls without ileal inflammation for age, sex, and type of proctocolectomies with ileal pouch construction (1- or 2-stage). We evaluated terminal ileal sections from original colectomies of 2213 patients with either UC or idiopathic inflammatory bowel disease of indeterminate type, collected during a 21-year period, for extent and severity of chronic and active ileitis. Clinical pouch outcomes were assessed through a longitudinally maintained clinical outcome database that systematically catalogued all short-term and long-term pouch complications, including pouchitis, sepsis, impaired long-term pouch survival, and conversion to Crohn's disease.
  
  
  RESULTS
  Regardless of severity or extent, backwash ileitis was not correlated with any clinical outcome examined, short-term or long-term.
  
  
  CONCLUSIONS
  Ileal inflammation is not a contraindication for restorative proctocolectomy with ileal pouch construction in patients with UC or idiopathic inflammatory bowel disease of indeterminate type. Ileal inflammation with pancolitis is not a useful criterion for classifying otherwise typical UC as colitis of indeterminate type, because pouch outcomes are not affected.
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Andrea V
authors.initials: AV
authors.lastname: Arrossi
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Kariv
authors.forename: Mary P
authors.initials: MP
authors.lastname: Bronner
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hammel
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: John R
authors.initials: JR
authors.lastname: Goldblum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D019449:Pouchitis / Q000453:epidemiology* / Q000473:pathology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult