Pouchitis after ileal pouch-anal anastomosis in ulcerative colitis: Diagnosis, management, risk factors, and incidence.
Restorative proctocolectomy with ileal pouch-anal anastomosis has been the surgical treatment of choice for patients with ulcerative colitis who require surgery. Quality of life after this procedure is satisfactory in most cases; however, pouchitis is a troublesome condition involving inflammation of the ileal pouch. When a patient presents with symptoms of pouchitis, such as increased bowel movements, mucous and/or bloody exudates, abdominal cramps, and fever, endoscopy is essential for a precise diagnosis. The proximal ileum and rectal cuff, as well as the ileal pouch, should be endoscopically observed. The reported incidence of pouchitis ranges from 14% to 59%, and antibiotic therapy is the primary treatment for acute pouchitis. Chronic pouchitis includes antibiotic-dependent and refractory pouchitis. Intensive therapy including antitumor necrosis factor antibodies and steroids may be necessary for antibiotic-refractory pouchitis, and pouch failure may occur despite such intensive treatment. Reported risk factors for the development of pouchitis include presence of extraintestinal manifestations, primary sclerosing cholangitis, non-smoking, and postoperative non-steroidal anti-inflammatory drug usage. In the present review, we focus on the diagnosis, endoscopic features, management, incidence, and risk factors of pouchitis in patients with ulcerative colitis who underwent ileal pouch-anal anastomosis.
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Keisuke
K
Hata
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Soichiro
S
Ishihara
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Hiroaki
H
Nozawa
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Kazushige
K
Kawai
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Tomomichi
T
Kiyomatsu
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Toshiaki
T
Tanaka
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Junko
J
Kishikawa
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Hiroyuki
H
Anzai
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Toshiaki
T
Watanabe
D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D003113:Colonoscopy / Q000379:methods*; D019468:Disease Management; D014943:Global Health; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology*; D019449:Pouchitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors
Crohn's disease of the pouch; cytapheresis; extraintestinal manifestation; pouchitis; ulcerative colitis