Understanding New Concepts: Clostridium difficile Infection in Pouch Patients

Excerpt

Inflammatory bowel disease (IBD) is a major medical condition that affects nearly 1.5 million Americans, with over 70,000 new cases diagnosed annually. Over the last 50 years, rapid advances in the understanding of its pathophysiology and diagnosis, combined with the utilization of emerging medical therapies have better controlled the disease, have decreased morbidity, and have prolonged survival. Yet, the lifelong risk of surgery in patients with Crohn’s disease (CD) was traditionally reported at 75 % and with ulcerative colitis (UC) at 25 %, numbers likely to stay unchanged. One of the frequent operations performed for patients with these diseases is restorative proctocolectomy with ileal pouch anal anastomosis (IPAA), a procedure reserved for patients with advanced UC refractory to currently available medical therapy or who develop colonic dysplasia or cancer. First described in 1978 by Parks and Nicholls [1], this procedure truly revolutionized patient care in that it maintained gut continuity and avoided the need for permanent ileostomy in patients with UC. Over the years, with technical improvements, it has also become the procedure of choice for patients with familial adenomatous polyposis syndrome requiring colectomy. …