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Erschienen in: Surgery Today 9/2014

01.09.2014 | Original Article

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

verfasst von: Takuzo Hashimoto, Michio Itabashi, Shinpei Ogawa, Tomoichiro Hirosawa, Yoshiko Bamba, Sanae Kaji, Mamiko Ubukata, Sayumi Nakao, Shingo Kameoka

Erschienen in: Surgery Today | Ausgabe 9/2014

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Abstract

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 < 0.0001). In addition, pouchitis had a greater tendency to recur in the cases with cuffitis than in those without (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.
Literatur
1.
Zurück zum Zitat 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;38:234–9.PubMedCentralPubMedCrossRef 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;38:234–9.PubMedCentralPubMedCrossRef
2.
Zurück zum Zitat 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;222:120–7.PubMedCentralPubMedCrossRef 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;222:120–7.PubMedCentralPubMedCrossRef
3.
Zurück zum Zitat 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;14:20–8.PubMedCrossRef 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;14:20–8.PubMedCrossRef
4.
Zurück zum Zitat 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;6:561–8.PubMedCentralPubMedCrossRef 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;6:561–8.PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Shen B. Acute and chronic pouchitis–pathogenesis, diagnosis and treatment. Nat Rev Gastroenterol Hepatol. 2012;9:323–33.PubMedCrossRef Shen B. Acute and chronic pouchitis–pathogenesis, diagnosis and treatment. Nat Rev Gastroenterol Hepatol. 2012;9:323–33.PubMedCrossRef
6.
Zurück zum Zitat Fukushima K, Fujii H, Yamamura T, Sugita A, Kameoka S, Nagawa H, et al. Pouchitis atlas for objective endoscopic diagnosis. J Gastroenterol. 2007;42:799–806.PubMedCrossRef Fukushima K, Fujii H, Yamamura T, Sugita A, Kameoka S, Nagawa H, et al. Pouchitis atlas for objective endoscopic diagnosis. J Gastroenterol. 2007;42:799–806.PubMedCrossRef
7.
Zurück zum Zitat 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. 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.
8.
Zurück zum Zitat 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;46:748–53.PubMedCrossRef 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;46:748–53.PubMedCrossRef
9.
Zurück zum Zitat 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.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.PubMedCrossRef
10.
Zurück zum Zitat Ståhlberg D, Gullberg K, Liljeqvist L, Hellers G, Löfberg R. Pouchitis following pelvic pouch operation for ulcerative colitis. Incidence, cumulative risk, and risk factors. Dis Colon Rectum. 1996;39:1012–8.PubMedCrossRef Ståhlberg D, Gullberg K, Liljeqvist L, Hellers G, Löfberg R. Pouchitis following pelvic pouch operation for ulcerative colitis. Incidence, cumulative risk, and risk factors. Dis Colon Rectum. 1996;39:1012–8.PubMedCrossRef
11.
Zurück zum Zitat Fujii H. Circumstances of Pouchitis—a questionnaire survey result (in Japanese). Annual report of the research committee of inflammatory bowel disease the ministry of health, labour and welfare of Japan. 2002;110–1. Fujii H. Circumstances of Pouchitis—a questionnaire survey result (in Japanese). Annual report of the research committee of inflammatory bowel disease the ministry of health, labour and welfare of Japan. 2002;110–1.
12.
Zurück zum Zitat Uchino M, Ikeuchi H, Matsuoka H, Bando T, Takesue Y, Tomita N. Clinical features and management of pouchitis in Japanese ulcerative colitis patients. Surg Today. 2013;43:1049–57.PubMedCrossRef Uchino M, Ikeuchi H, Matsuoka H, Bando T, Takesue Y, Tomita N. Clinical features and management of pouchitis in Japanese ulcerative colitis patients. Surg Today. 2013;43:1049–57.PubMedCrossRef
14.
Zurück zum Zitat 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;225:666–76.PubMedCentralPubMedCrossRef 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;225:666–76.PubMedCentralPubMedCrossRef
15.
Zurück zum Zitat 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;2:142–51.PubMedCrossRef 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;2:142–51.PubMedCrossRef
16.
Zurück zum Zitat Sandborn WJ. Pouchitis: definition, risk factors, frequency, natural history, classification and public health perspective. In: McLeod RS, Martin F, Sutherland LR, editors. Trends in inflammatory bowel disease 1996. UK: Kluwer Academic Publishers; 1997. p. 51–63. Sandborn WJ. Pouchitis: definition, risk factors, frequency, natural history, classification and public health perspective. In: McLeod RS, Martin F, Sutherland LR, editors. Trends in inflammatory bowel disease 1996. UK: Kluwer Academic Publishers; 1997. p. 51–63.
17.
Zurück zum Zitat 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;211:622–7.PubMedCentralPubMed 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;211:622–7.PubMedCentralPubMed
18.
Zurück zum Zitat Lavery IC, Sirimarco MT, Ziv Y, Fazio VW. Anal canal inflammation after ileal pouch-anal anastomosis. The need for treatment. Dis Colon Rectum. 1995;38:803–6.PubMedCrossRef Lavery IC, Sirimarco MT, Ziv Y, Fazio VW. Anal canal inflammation after ileal pouch-anal anastomosis. The need for treatment. Dis Colon Rectum. 1995;38:803–6.PubMedCrossRef
19.
Zurück zum Zitat 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;99:1527–31.PubMedCrossRef 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;99:1527–31.PubMedCrossRef
20.
Zurück zum Zitat Wu B, Lian L, Li Y, Remzi FH, Liu X, Kiran RP, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch-anal anastomoses. Inflamm Bowel Dis. 2013;19:404–10.PubMedCrossRef Wu B, Lian L, Li Y, Remzi FH, Liu X, Kiran RP, et al. Clinical course of cuffitis in ulcerative colitis patients with restorative proctocolectomy and ileal pouch-anal anastomoses. Inflamm Bowel Dis. 2013;19:404–10.PubMedCrossRef
Metadaten
Titel
A treatment strategy for preventing pouchitis as a postoperative complication of ulcerative colitis: the significance of the management of cuffitis
verfasst von
Takuzo Hashimoto
Michio Itabashi
Shinpei Ogawa
Tomoichiro Hirosawa
Yoshiko Bamba
Sanae Kaji
Mamiko Ubukata
Sayumi Nakao
Shingo Kameoka
Publikationsdatum
01.09.2014
Verlag
Springer Japan
Erschienen in
Surgery Today / Ausgabe 9/2014
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-014-0974-5

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