Clinical Features of Refractory Pouchitis with  Penetrating Lesions and the Efficacy of Infliximab  Treatment for Patients with Ulcerative Colitis  after Restorative Proctocolectomy.
BACKGROUND
Chronic pouchitis with penetrating anal lesions often leads to pouch failure after restorative proctocolectomy. The aim of this study was to analyze those predictors and to evaluate the effects of infliximab (IFX).


METHODS
We reviewed patients’ backgrounds and performed a prospective trial of IFX treatment. Possible pre-operative factors were analyzed. Efficacy was assessed by comparing the pouchitis disease activity index (PDAI) and peri-anal DAI. Long-term efficacy was assessed via the rate of pouch failure.


RESULTS
A total of 41 patients with refractory pouchitis were included. Although the patients with penetrating lesions were younger than those without, neither predictive pre-operative factors nor a correlation of C-related protein levels were observed. A total of 10 patients with penetrating lesions were enrolled for IFX treatment. Although the PDAI and peri-anal DAI decreased significantly (p = 0.04 and p = 0.02, respectively), the primary non-responders during the induction of IFX were 3 patients with obvious abscesses. The 1-year cumulative pouch failure rate was 0% in patients without abscesses and 50% in patients with abscesses under IFX maintenance.


CONCLUSIONS
IFX treatment for refractory pouchitis with penetrating complications appears to be effective. However, once penetrating lesions develop to abscesses, these lesions are difficult to heal.
Motoi
M
Uchino
Hiroki
H
Ikeuchi
Toshihiro
T
Bando
Kei
K
Hirose
Akihiro
A
Hirata
Teruhiro
T
Chohno
Hirofumi
H
Sasaki
Yuki
Y
Horio
Yoshiko
Y
Takahashi
Yoshio
Y
Takesue
Nobuyuki
N
Hida
Kazutoshi
K
Hori
Shiro
S
Nakamura
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy*; D019449:Pouchitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D005765:Gastrointestinal Agents; D000069285:Infliximab