Top

Published in:

Open Access 01-03-2013 | Original Article

Characteristics of Extremely Early-Onset Pouchitis after Proctocolectomy with Ileal Pouch–Anal Anastomosis

Authors: Yoshiki Okita, Toshimitsu Araki, Koji Tanaka, Tadanobu Shimura, Mikio Kawamura, Hiroyuki Fujikawa, Mikihiro Inoue, Yasuhiro Inoue, Keiichi Uchida, Yasuhiko Mohri, Masato Kusunoki

Published in: Journal of Gastrointestinal Surgery | Issue 3/2013

Abstract

Objective

This study aims to evaluate the clinical characteristics of patients with postoperative ulcerative colitis developing extremely early-onset pouchitis within 4 weeks of restoration of gastrointestinal continuity.

Material and Methods

This retrospective study involved 225 consecutive patients from January 2000 to May 2011 who underwent ileal pouch–anal anastomosis for ulcerative colitis with a minimum follow-up of 12 months. Extremely early-onset pouchitis was defined as pouchitis developing within 4 weeks of restoration of gastrointestinal continuity. Patients with pouchitis were divided into extremely early-onset pouchitis and non-extremely early-onset pouchitis groups for comparison.

Results

Of 212 patients who met the inclusion criteria, 62 had pouchitis (29.2 %). Eight (3.8 %) patients developed extremely early-onset pouchitis. There was a significant difference in the dosage of steroid per month just before colectomy between the two groups (P = 0.039). The modified Pouchitis Disease Activity Index score for patients with extremely early-onset pouchitis was higher than in patients with non-extremely early-onset pouchitis (P = 0.0009). The occurrence of extremely early-onset pouchitis was associated with the development of chronic pouchitis (P = 0.0056).

Conclusion

Extremely early-onset pouchitis may be related to high steroid dosages before colectomy and may be more severe than pouchitis that occurs >4 weeks after restoration of gastrointestinal continuity.

Shen B, Fazio VW, Remzi FH, Delaney CP, Bennett AE, Achkar JP, Brzezinski A, Khandwala F, Liu W, Bambrick ML, Bast J, Lashner B. Comprehensive evaluation of inflammatory and noninflammatory sequelae of ileal pouch–anal anastomoses. Am J Gastroenterol 2005; 100: 93–101.PubMedCrossRef

Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F. Prospective study of the incidence, timing and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg 1996; 131: 497–500; discussion 501–492.PubMedCrossRef

Simchuk EJ, Thirlby RC. Risk factors and true incidence of pouchitis in patients after ileal pouch-anal anastomoses. World J Surg 2000; 24: 851–856.PubMedCrossRef

Stahlberg D, Gullberg K, Liljeqvist L, Hellers G, Lofberg R. Pouchitis following pelvic pouch operation for ulcerative colitis. Incidence, cumulative risk, and risk factors. Dis Colon Rectum 1996; 39: 1012–1018.PubMedCrossRef

Penna C, Dozois R, Tremaine W, Sandborn W, LaRusso N, Schleck C, Ilstrup D. Pouchitis after ileal pouch–anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut 1996; 38: 234–239.PubMedCrossRef

Lohmuller JL, Pemberton JH, Dozois RR, Ilstrup D, van Heerden J. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg 1990; 211: 622–627; discussion 627–629.PubMed

Mignon M, Stettler C, Phillips SF. Pouchitis—a poorly understood entity. Dis Colon Rectum 1995; 38: 100–103.PubMedCrossRef

Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis 1986; 1: 167–174.PubMedCrossRef

Yu ED, Shao Z, Shen B. Pouchitis. World J Gastroenterol 2007; 13: 5598–5604.PubMed

10.

Shen B, Achkar JP, Connor JT, Ormsby AH, Remzi FH, Bevins CL, Brzezinski A, Bambrick ML, Fazio VW, Lashner BA. Modified pouchitis disease activity index: a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum 2003; 46: 748–753.PubMedCrossRef

11.

Pardi DS, D'Haens G, Shen B, Campbell S, Gionchetti P. Clinical guidelines for the management of pouchitis. Inflamm Bowel Dis 2009; 15: 1424–1431.PubMedCrossRef

12.

Abdelrazeq AS, Kandiyil N, Botterill ID, Lund JN, Reynolds JR, Holdsworth PJ, Leveson SH. Predictors for acute and chronic pouchitis following restorative proctocolectomy for ulcerative colitis. Colorectal Dis 2008; 10: 805–813.PubMedCrossRef

13.

Fleshner P, Ippoliti A, Dubinsky M, Ognibene S, Vasiliauskas E, Chelly M, Mei L, Papadakis KA, Landers C, Targan S. A prospective multivariate analysis of clinical factors associated with pouchitis after ileal pouch–anal anastomosis. Clin Gastroenterol Hepatol 2007; 5: 952–958; quiz 887.PubMedCrossRef

14.

Okon A, Dubinsky M, Vasiliauskas EA, Papadakis KA, Ippoliti A, Targan SR, Fleshner PR. Elevated platelet count before ileal pouch–anal anastomosis for ulcerative colitis is associated with the development of chronic pouchitis. Am Surg 2005; 71: 821–826.PubMed

15.

Ikeuchi H, Nakano H, Uchino M, Nakamura M, Yanagi H, Noda M, Yamamura T. Incidence and therapeutic outcome of pouchitis for ulcerative colitis in Japanese patients. Dig Surg 2004; 21: 197–201.PubMedCrossRef

16.

Achkar JP, Al-Haddad M, Lashner B, Remzi FH, Brzezinski A, Shen B, Khandwala F, Fazio V. Differentiating risk factors for acute and chronic pouchitis. Clin Gastroenterol Hepatol 2005; 3: 60–66.PubMedCrossRef

17.

Hata K, Watanabe T, Shinozaki M, Nagawa H. Patients with extraintestinal manifestations have a higher risk of developing pouchitis in ulcerative colitis: multivariate analysis. Scand J Gastroenterol 2003; 38: 1055–1058.PubMedCrossRef

18.

Wasmuth HH, Trano G, Endreseth BH, Wibe A, Rydning A, Myrvold HE. Primary sclerosing cholangitis and extraintestinal manifestations in patients with ulcerative colitis and ileal pouch-anal anastomosis. J Gastrointest Surg 2010; 14: 1099–1104.PubMedCrossRef

19.

Kalkan IH, Dagli U, Onder FO, Tunc B, Oztas E, Ulker A, Sasmaz N (2012) Evaluation of preoperative predictors of development of pouchitis after ileal–pouch anastomosis in ulcerative colitis. Clin Res Hepatol Gastroenterol 36(6):622–627.PubMedCrossRef

20.

Nakamura M, Ikeuchi H, Nakano H, Uchino M, Noda M, Yanagi H, Yamamura T. Postoperative joint symptoms: a risk factor for pouchitis in ulcerative colitis patients. Dig Surg 2006; 23: 60–64.PubMedCrossRef

21.

Suzuki H, Ogawa H, Shibata C, Haneda S, Watanabe K, Takahashi K, Funayama Y, Sasaki I. The long-term clinical course of pouchitis after total proctocolectomy and IPAA for ulcerative colitis. Dis Colon Rectum 2012; 55: 330–336.PubMedCrossRef

22.

Hoda KM, Collins JF, Knigge KL, Deveney KE. Predictors of pouchitis after ileal pouch–anal anastomosis: a retrospective review. Dis Colon Rectum 2008; 51:554–560.PubMedCrossRef

23.

Fukushima K, Fujii H, Yamamura T, Sugita A, Kameoka S, Nagawa H, Futami K, Watanabe T, Hatakeyama K, Sawada T, Yoshioka K, Kusunoki M, Konishi F, Watanabe M, Takahashi K, Ogawa H, Funayama Y, Hibi T, Sasaki I; Surgical Research Group, the Research Committee of Inflammatory Bowel Disease, Ministry of Health, Labour and Welfare of Japan. Pouchitis atlas for objective endoscopic diagnosis. J Gastroenterol 2007; 42: 799–806.PubMedCrossRef

Title: Characteristics of Extremely Early-Onset Pouchitis after Proctocolectomy with Ileal Pouch–Anal Anastomosis
Authors: Yoshiki Okita
Toshimitsu Araki
Koji Tanaka
Tadanobu Shimura
Mikio Kawamura
Hiroyuki Fujikawa
Mikihiro Inoue
Yasuhiro Inoue
Keiichi Uchida
Yasuhiko Mohri
Masato Kusunoki
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-2120-2

At a glance: The STEP trials

Springer Medicine

Characteristics of Extremely Early-Onset Pouchitis after Proctocolectomy with Ileal Pouch–Anal Anastomosis

Abstract

Objective

Material and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Material and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2013

Does Presoaking Synthetic Mesh in Antibiotic Solution Reduce Mesh Infections? An Experimental Study

LigaSure™ Vs. Conventional Dissection Techniques in Pancreatic Surgery—a Prospective Randomised Single-Centre Trial

Laparoscopic Colorectal Surgery for Obese Patients: Decreased Conversions with the Hand-Assisted Technique

Circadian Gene Expression and Clinicopathologic Correlates in Pancreatic Cancer

The Prognostic Influence of Resection Margin Clearance Following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Perioperative Complications After Neoadjuvant Chemotherapy With and Without Bevacizumab for Colorectal Liver Metastases