A treatment strategy for preventing pouchitis as a postoperative complication of ulcerative colitis: the significance of the management of cuffitis

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• 作者：Takuzo Hashimoto (1)
  Michio Itabashi (1)
  Shinpei Ogawa (1)
  Tomoichiro Hirosawa (1)
  Yoshiko Bamba (1)
  Sanae Kaji (1)
  Mamiko Ubukata (1)
  Sayumi Nakao (1)
  Shingo Kameoka (1)
  
• 关键词：Ulcerative colitis ; Pouchitis ; Cuffitis
• 刊名：Surgery Today
• 出版年：2014
• 出版时间：September 2014
• 年：2014
• 卷：44
• 期：9
• 页码：1730-1734
• 全文大小：286 KB
• 参考文献：1. Penna C, Dozois R, Tremaine W, Sandborn W, LaRusso N, Schleck C, et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut. 1996;38:234-. CrossRef
  2. Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg. 1995;222:120-. CrossRef
  3. Ferrante M, Declerck S, De Hertogh G, Van Assche G, Geboes K, Rutgeerts P, et al. Outcome after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Inflamm Bowel Dis. 2008;14:20-. CrossRef
  4. Fleshner P, Ippoliti A, Dubinsky M, Vasiliauskas E, Mei L, Papadakis KA, et al. Both preoperative perinuclear antineutrophil cytoplasmic antibody and anti-CBir1 expression in ulcerative colitis patients influence pouchitis development after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol. 2008;6:561-. CrossRef
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  7. Pouchitis atlas for objective endoscopic diagnosis (in Japanese). Annual report of the research committee of inflammatory bowel disease the ministry of health, labour and welfare of Japan. 2011;17-.
  8. Shen B, Achkar JP, Connor JT, Ormsby AH, Remzi FH, Bevins CL, et al. Modified pouchitis disease activity index: a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum. 2003;46:748-3. CrossRef
  9. 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;131:497-00. CrossRef
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  14. Reilly WT, Pemberton JH, Wolff BG, Nivatvongs S, Devine RM, Litchy WJ, et al. Randomized prospective trial comparing ileal pouch-anal anastomosis performed by excising the anal mucosa to ileal pouch-anal anastomosis performed by preserving the anal mucosa. Ann Surg. 1997;225:666-6. CrossRef
  15. Ferrante M, Declerck S, Coopmans T, De Hertogh G, Van Assche G, Penninckx F, et al. Development of pouchitis following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis: a role for serological markers and microbial pattern recognition receptor genes. J Crohns Colitis. 2008;2:142-1. CrossRef
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  19. Shen B, Lashner BA, Bennett AE, Remzi FH, Brzezinski A, Achkar JP, et al. Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis. Am J Gastroenterol. 2004;99:1527-1. CrossRef
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• 作者单位：Takuzo Hashimoto (1)
  Michio Itabashi (1)
  Shinpei Ogawa (1)
  Tomoichiro Hirosawa (1)
  Yoshiko Bamba (1)
  Sanae Kaji (1)
  Mamiko Ubukata (1)
  Sayumi Nakao (1)
  Shingo Kameoka (1)
  
  1. Department of Surgery II, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
  
• ISSN：1436-2813

文摘

Purpose The aim of this study was to examine the risk factors for and to evaluate strategies for preventing pouchitis as a postoperative complication of ulcerative colitis (UC). Methods A total of 119 cases of UC in which restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) was performed at our institution between 2000 and 2012 was investigated; nine patients in whom it was impossible to close the ileostomy due to an intractable anal fistula or pelvic abscess were excluded. Results The cumulative risk of developing pouchitis 5?years after IPAA with stoma closure was 31.0?%. Significant relationships with pouchitis were found for the surgical indication (p?=?0.0126) and surgical method (p?=?0.0214). A significant correlation was found between pouchitis and cuffitis. Pouchitis was significantly more common in the cases with cuffitis than in those without (p?=?0.0002). There was also a significantly different cumulative incidence observed between the cases with and without cuffitis (p?p?=?0.2730). Conclusion The cumulative incidence rate of pouchitis was 10.6?% at 1?year, 15.1?% at 2?years and 31.0?% at 5?years. Controlling cuffitis is important to prevent pouchitis.