title: The long-term clinical course of pouchitis after total proctocolectomy and IPAA for ulcerative colitis.
abstract: BACKGROUND
  Pouchitis is the most common long-term complication after restorative total proctocolectomy and IPAA for ulcerative colitis.
  
  
  OBJECTIVE
  We examined the incidence, clinical aspects, and long-term outcome of patients with idiopathic pouchitis.
  
  
  METHODS
  This study was a retrospective review of medical records.
  
  
  METHODS
  Included in the study were 284 patients with ulcerative colitis who underwent a total proctocolectomy and IPAA.
  
  
  METHODS
  We evaluated the cumulative risk and long-term outcome of pouchitis including the duration of disease, pattern of relapse, and responsiveness to antibiotic therapy.
  
  
  RESULTS
  Sixty-four patients developed idiopathic pouchitis. The cumulative risk was 10.7% at 1 year, 17.2% at 2 years, 24.0% at 5 years, and 38.2% at 10 years. At their first pouchitis episode, 45 patients had acute pouchitis, 19 patients had chronic pouchitis, and all patients received antibiotic therapy with oral ciprofloxacin and/or metronidazole. The efficacy of the therapy was 96.6% initially. Forty-five patients had antibiotic-responsive pouchitis, 17 patients had antibiotic-dependent pouchitis, and 2 patients had antibiotic-refractory pouchitis at their first episode. Whereas 20 of 45 patients (44.4%) with initially acute pouchitis experienced 2 or more relapses, 16 of 19 patients (84.2%) with initially chronic pouchitis had 2 or more relapses. After taking into account the relapses, the number of patients with antibiotic-responsive pouchitis decreased from 45 to 40, the number with antibiotic-dependent pouchitis increased from 17 to 20, and the number with antibiotic-refractory pouchitis increased from 2 to 4. Among the 4 patients with antibiotic-refractory pouchitis, 3 patients had Clostridium difficile-associated pouchitis.
  
  
  CONCLUSIONS
  This study was retrospective.
  
  
  CONCLUSIONS
  The patients with chronic pouchitis at the first episode tend to have a higher incidence of relapse. In some patients, the responsiveness to antibiotic therapy changes during follow-up. When patients with pouchitis do not respond to standard antibiotic therapy, then the occurrence of C difficile infection should be considered.
authors.affiliation: Division of Biological Regulation and Oncology, Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogawa
authors.forename: Chikashi
authors.initials: C
authors.lastname: Shibata
authors.forename: Sho
authors.initials: S
authors.lastname: Haneda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Takahashi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Funayama
authors.forename: Iwao
authors.initials: I
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D019449:Pouchitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D002939:Ciprofloxacin