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Implications of Pouchitis on the Functional Results Following Stapled Restorative Proctocolectomy

  • Original Contributions
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Diseases of the Colon & Rectum

PURPOSE

Pouchitis is the most frequent long-term complication of restorative proctocolectomy; its long-term consequences are inadequately described. This prospective study evaluates the effect of pouchitis on the functional results, general health perception, and patient satisfaction.

METHODS

A total of 100 consecutive patients who underwent stapled restorative proctocolectomy for ulcerative colitis were divided into three groups: no pouchitis, acute pouch-itis and chronic pouchitis. Functional results, general health perception, and satisfaction of each group at the latest review were compared only when patients were not symptomatic of active pouchitis.

RESULTS

Pouchitis occurred in 33 patients (17 acute and 16 chronic). There were no significant differences in the long-term functional results between the no pouchitis and acute pouchitis groups. Patients who experienced chronic pouchitis had a significant increase in bowel movements, looseness of stools, urgency, nocturnal seepage, perianal excoriation, and dietary restrictions (P < 0.05). They also had a worse perception of their general health (P < 0.05). Previous chronic pouchitis had no effect on continence, daytime soilage, or gas–feces discrimination. Most patients were satisfied, despite pouchitis, and would recommend the operation to someone else with ulcerative colitis.

CONCLUSIONS

Acute pouchitis is easily treated and results in minimal functional consequences. Even in the absence of clinically active pouchitis, patients who had suffered from chronic pouchitis had poorer functional results and general health perception. This may overshadow the benefits of restorative proctocolectomy. This finding suggests that acute and chronic pouchitis are distinct disease entities and chronic pouchitis may represent a persistent condition that displays episodic symptomatic exacerbation.

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REFERENCES

  1. VW Fazio Y Ziv JM Church et al. (1995) ArticleTitleIleal pouch-anal anastomosis complications and function in 1005 patients Ann Surg 222 120–7 Occurrence Handle7639579

    PubMed  Google Scholar 

  2. AP Meagher R Farouk RR Dozois KA Kelly JH Pemberton (1998) ArticleTitleJ ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1310 patients Br J Surg 85 800–3 Occurrence Handle10.1046/j.1365-2168.1998.00689.x Occurrence Handle9667712

    Article  PubMed  Google Scholar 

  3. PW Marcello PL Roberts DJ Schoetz SuffixJr JA Coller JJ Murray MC Veidenheimer (1993) ArticleTitleLong-term results of the ileo-anal pouch procedure Arch Surg 128 500–3 Occurrence Handle8489382

    PubMed  Google Scholar 

  4. JM Becker KM McGrath MP Meagher JE Parodi DA Dunnegan NJ Soper (1991) ArticleTitleLate functional adaptation after colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis Surgery 110 718–25 Occurrence Handle1925961

    PubMed  Google Scholar 

  5. JH Pemberton SF Phillips RR Ready AR Zinsmeister OH Beahrs (1989) ArticleTitleQuality of life after Brooke ileostomy and ileal pouch-anal anastomosis: comparison of performance status Ann Surg 209 620–6 Occurrence Handle2539790

    PubMed  Google Scholar 

  6. ED Skarsgard KG Atkinson GA Bell ME Pezim AM Seal FR Sharp (1989) ArticleTitleFunction and quality of life results after ileal pouch surgery for chronic ulcerative colitis and familial polyposis Am J Surg 157 467–71 Occurrence Handle10.1016/0002-9610(89)90636-3 Occurrence Handle2540665

    Article  PubMed  Google Scholar 

  7. HJ Silva Particlede CP Angelis Particlede N Soper MG Kettlewell NJ Mortensen DP Jewell (1991) ArticleTitleClinical and functional outcome after restorative proctocolectomy Br J Surg 78 1039–44 Occurrence Handle1933182

    PubMed  Google Scholar 

  8. UM Mahadevan WJ Sandborn (2003) ArticleTitleDiagnosis and management of pouchitis Gastroenterol 124 1636–50 Occurrence Handle10.1016/S0016-5085(03)00325-1

    Article  Google Scholar 

  9. JH Pemberton KA Kelly RW Beart SuffixJr RR Dozois BG Wolff DM Ilstrup (1987) ArticleTitleIleal pouch-anal anastomosis for chronic ulcerative colitis: long-term results Ann Surg 206 504–13 Occurrence Handle3662660

    PubMed  Google Scholar 

  10. G Febo ParticleDi M Miglioli A Lauri et al. (1990) ArticleTitleEndoscopic assessment of acute inflammation of the ileal reservoir after restorative ileo-anal anastomosis Gastrointest Endosc 36 6–9 Occurrence Handle2155847

    PubMed  Google Scholar 

  11. NA Shepherd JR Jass I Duval RL Moskowitz RJ Nicholls BC Morson (1987) ArticleTitleRestorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens J Clin Pathol 40 601–7 Occurrence Handle3611389

    PubMed  Google Scholar 

  12. RR Dozois SM Goldberg DA Rothenberger et al. (1986) ArticleTitleRestorative proctocolectomy with ileal reservoir Int J Colorectal Dis 1 2–19 Occurrence Handle10.1007/BF01648830 Occurrence Handle3036974

    Article  PubMed  Google Scholar 

  13. EJ Simchuk RC Thirlby (2000) ArticleTitleRisk factors and true incidence of pouchitis in patients after ileal pouch-anal anastomosis World J Surg 24 851–6 Occurrence Handle10.1007/s002680010136 Occurrence Handle10833254

    Article  PubMed  Google Scholar 

  14. K Geboes R Riddel A Ost B Jensfelt T Persson R Lofberg (2000) ArticleTitleA reproducible grading scale for histological assessment of inflammation in ulcerative colitis Gut 47 404–9 Occurrence Handle10.1136/gut.47.3.404 Occurrence Handle10940279

    Article  PubMed  Google Scholar 

  15. RM Weinryb JP Gustavsson L Liljeqvist B Poppen RJ Rossel (1995) ArticleTitleA prospective study of the quality of life after pelvic pouch operation J Am Coll Surg 180 589–95 Occurrence Handle7749536

    PubMed  Google Scholar 

  16. RL Moskowitz NA Shepherd RJ Nicholls (1986) ArticleTitleAn assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir Int J Colorectal Dis 1 167–74 Occurrence Handle10.1007/BF01648445 Occurrence Handle3039030

    Article  PubMed  Google Scholar 

  17. WJ Sandborn WJ Tremaine KP Batts JH Pemberton SF Phillips (1994) ArticleTitlePouchitis following ileal pouch-anal anastomosis: a Pouchitis Disease Activity Index Mayo Clin Proc 69 409–15 Occurrence Handle8170189

    PubMed  Google Scholar 

  18. PR Fleshner EA Vasiliauskas LY Kam et al. (2001) ArticleTitleHigh level perinuclear antineutrophil cytoplasmic antibody (p-ANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis Gut 49 671–7 Occurrence Handle10.1136/gut.49.5.671 Occurrence Handle11600470

    Article  PubMed  Google Scholar 

  19. PB McIntyre JH Pemberton BG Wolff RW Beart RR Dozois (1994) ArticleTitleComparing functional results one year and ten years after ileal pouch-anal anastomosis for chronic ulcerative colitis Dis Colon Rectum 37 303–7 Occurrence Handle10.1007/BF02053588 Occurrence Handle8168407

    Article  PubMed  Google Scholar 

  20. RD Hurst TP Chung M Rubin F Michelassi (1998) ArticleTitleThe implications of acute pouchitis on the long-term functional results after restorative proctocolectomy Inflamm Bowel Dis 4 280–4 Occurrence Handle9836080

    PubMed  Google Scholar 

  21. JL Lohmuller JH Pemberton RR Dozios D Ilstup J Heerden Particlevan (1990) ArticleTitlePouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis Ann Surg 211 622–9 Occurrence Handle2339922

    PubMed  Google Scholar 

  22. P Luukkonen H Jarvinen M Tanskanen A Kahri (1994) ArticleTitlePouchitis—recurrence of inflammatory bowel disease? Gut 35 243–6 Occurrence Handle8307476

    PubMed  Google Scholar 

  23. DG Nasmyth D Johnston PG Godwin MF Dixon A Smith NS Williams (1986) ArticleTitleFactors influencing bowel function after ileal pouch-anal anastomosis Br J Surg 73 469–73 Occurrence Handle3719274

    PubMed  Google Scholar 

  24. BT Gelmo WD Wong DA Rothenberger SM Goldberg (1992) ArticleTitleIleal pouch-anal anastomosis; patterns of failure Arch Surg 127 784–7 Occurrence Handle1524477

    PubMed  Google Scholar 

  25. G Svaniger S Nordgren T Oresland L Hulten (1993) ArticleTitleIncidence and characteristics of pouchitis in Kock continent ileostomy and the pelvic pouch Scand J Gastroenterol 28 695–700 Occurrence Handle8210985

    PubMed  Google Scholar 

  26. DG Nasmyth PG Godwin MF Dixon NS Williams D Johnston (1989) ArticleTitleIleal ecology after pouch-anal anastomosis or ileostomy: a study of mucosal morphology, fecal bacteriology, fecal volatile fatty acids, and their interrelationship Gastroenterology 96 817–24 Occurrence Handle2914643

    PubMed  Google Scholar 

  27. SM Rauh DJ Schoetz SuffixJr PL Roberts JJ Murray JA Coller MC Veindenheimer (1991) ArticleTitlePouchitis–is it a wastebasket diagnosis? Dis Colon Rectum 34 685–9 Occurrence Handle10.1007/BF02050351 Occurrence Handle1649737

    Article  PubMed  Google Scholar 

  28. CM Schmidt AJ Lazenby RJ Hendrickson JV Sitzmann (1998) ArticleTitlePreoperative terminal ileal and colonic resection histopathology predicts risk of pouchitis in patients after ileoanal pull-through procedure Ann Surg 227 654–65 Occurrence Handle10.1097/00000658-199805000-00006 Occurrence Handle9605657

    Article  PubMed  Google Scholar 

  29. MN Merrett N Sober N Mortensen DP Jewell (1996) ArticleTitleIntestinal permeability in the ileal pouch Gut 39 226–30 Occurrence Handle8991861

    PubMed  Google Scholar 

  30. P Setti-Carraro IC Talbot RJ Nicholls (1994) ArticleTitleLong-term appraisal of the histological appearances of the ileal reservoir mucosa after restorative proctocoloectomy for ulcerative colitis Gut 35 1721–7 Occurrence Handle7829009

    PubMed  Google Scholar 

  31. J Tiainen M Matikainen (2000) ArticleTitleLong-term clinical outcome and anaemia after restorative proctocolectomy for ulcerative colitis Scand J Gastroenterol 35 1170–3 Occurrence Handle10.1080/003655200750056646 Occurrence Handle11145288

    Article  PubMed  Google Scholar 

  32. M Al-Haddad JP Achkar F Khandwala et al. (2004) ArticleTitlePredictors of acute and chronic pouchitis Gastroenterol 126 1367

    Google Scholar 

  33. AS Abdelrazeq TR Wilson JN Lund SH Leveson (2004) ArticleTitlePouchitis incidence and risk factors after totally stapled restorative proctocolectomy Br J Surg 91 15

    Google Scholar 

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ACKNOWLEDGMENTS

The authors thank Dr. D. Leash, M.R.C.Path., for reviewing the pouch biopsies and the proctocolectomy histopathology, Mr. E. Grant from the Department of Clinical Effectiveness for assistance with statistical analysis, and Dr. R. Jeavons and Professor J. Clark of York University for reviewing the manuscript.

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Authors and Affiliations

  1. Colorectal Unit, Department of Surgery, York Hospital, York, United Kingdom

    Ayman S. Abdelrazeq M.S., F.R.C.S., Jonathan N. Lund D.M., F.R.C.S. & Stephen  H. Leveson M.D., F.R.C.S.

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  1. Ayman S. Abdelrazeq M.S., F.R.C.S.
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  2. Jonathan N. Lund D.M., F.R.C.S.
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  3. Stephen  H. Leveson M.D., F.R.C.S.
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Correspondence to Ayman S. Abdelrazeq M.S., F.R.C.S..

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Abdelrazeq, A., Lund, J. & Leveson, S. Implications of Pouchitis on the Functional Results Following Stapled Restorative Proctocolectomy. Dis Colon Rectum 48, 1700–1707 (2005). https://doi.org/10.1007/s10350-005-0058-0

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