Clinical features and management of pouchitis in Japanese ulcerative colitis patients.
OBJECTIVE
Pouchitis frequently occurs after restorative proctocolectomy for ulcerative colitis. This study evaluated the incidence and treatment of pouchitis in Japanese ulcerative colitis patients.


METHODS
This study reviewed the clinical data from 772 patients with pouch surgery between January 2000 and December 2010. Pouchitis was classified as acute or chronic pouchitis. The potential preoperative risk factors for overall and chronic pouchitis were analyzed using a logistic regression analysis.


RESULTS
The incidence of overall pouchitis and the cumulative risk of developing overall pouchitis were 10.0 % (77/772) and 10.7 % after 10 years, respectively. In addition, 74.0 % of all patients who developed overall pouchitis did so within 2 years after surgery. Chronic pouchitis occurred in 37.7 %. Although no independent risk factor for overall pouchitis was found, age at the onset of ulcerative colitis <26 years and surgical indications of toxic megacolon were found to be risk factors for chronic pouchitis and surgical indications of cancer/dysplasia were significantly associated with a low risk of overall pouchitis and patients with cancer/dysplasia were older than patients with other surgical indications (p < 0.01).


CONCLUSIONS
Immune abnormalities in younger onset patients or toxic megacolon may be more significant than surgical indications of cancer/dysplasia in elderly patients. Fundamental immune abnormalities may remain even after proctocolectomy.
Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. motoi.uchino@nifty.ne.jp
Motoi
M
Uchino
Hiroki
H
Ikeuchi
Hiroki
H
Matsuoka
Toshihiro
T
Bando
Yoshio
Y
Takesue
Naohiro
N
Tomita
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D044466:Asian People; D002648:Child; D002908:Chronic Disease; D002939:Ciprofloxacin / Q000008:administration & dosage; D003093:Colitis, Ulcerative / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007154:Immune System Diseases / Q000150:complications; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008532:Megacolon, Toxic / Q000601:surgery; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D019449:Pouchitis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D008795:Metronidazole; D002939:Ciprofloxacin