scholarly journals Preoperative Endoscopic Activity Predicts the Occurrence of Pouchitis After Ileal Pouch–Anal Anastomosis in Ulcerative Colitis: A Multicenter Retrospective Study in China

2021 ◽  
Vol 8 ◽  
Author(s):  
Weimin Xu ◽  
Wenbo Tang ◽  
Wenjun Ding ◽  
Hang Hu ◽  
Wenhao Chen ◽  
...  

Background: Pouchitis is the most common long-term complication after ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis (UC). Ulcerative colitis endoscopic index of severity (UCEIS) and Mayo endoscopic score (MES) are widely used indices to evaluate endoscopic activity. This study aimed to clarify the predictive value of preoperative endoscopic activity on the occurrence of pouchitis after IPAA.Methods: Data of patients with UC who underwent IPAA from January 2008 to January 2020 were collected retrospectively. UCEIS and MES were based on the preoperative colonoscopy findings of two independent endoscopists.Results: A total of 102 patients with a median follow-up of 5 (interquartile range, 2–9) years were included in the study. Among them, 21.6% developed pouchitis. Compared with MES, UCEIS had a stronger correlation with pouchitis disease activity index. UCEIS ≥ 7 had the most significant receiver-operating characteristic (ROC) curve area of 0.747 with a sensitivity of 68.2% and specificity of 81.2% in predicting pouchitis, which outperformed MES of 3 with an ROC area of 0.679 with a sensitivity of 54.5% and specificity of 81.2%. Furthermore, we found that UCEIS ≥ 7 was an independent risk factor for post-IPAA pouchitis [odds ratio (OR), 8.860; 95% CI, 1.969–39.865, p < 0.001] with a higher risk than MES of 3 (OR, 5.200; 95% CI, 1.895–14.273; p = 0.001).Conclusion: Ulcerative colitis endoscopic index of severity performed better in predicting pouchitis after IPAA than MES. Earlier and more frequent postoperative colonoscopic surveillance should be considered in patients with preoperative UCEIS ≥ 7 to detect the occurrence of pouchitis earlier.

1994 ◽  
Vol 69 (5) ◽  
pp. 409-415 ◽  
Author(s):  
WILLIAM J. SANDBORN ◽  
WILLIAM J. TREMAINE ◽  
KENNETH P. BATTS ◽  
JOHN H. PEMBERTON ◽  
SIDNEY F. PHILLIPS

2019 ◽  
Vol 20 (13) ◽  
pp. 1399-1408 ◽  
Author(s):  
Cigdem Benlice ◽  
Bo Shen ◽  
Scott R. Steele

Approximately 50% of patients who have undergone IPAA surgery for Ulcerative Colitis (UC) develop at least 1 episode of pouchitis. Patients with pouchitis have a wide range of symptoms, endoscopic and histologic features, disease course, and prognosis. To date, there are no universally accepted diagnostic criteria in terms of endoscopy and histology; though, semi-objective assessments to diagnose pouchitis in patients with ileal pouch- anal anastomosis (IPAA) have been proposed using composite scores such as the Pouchitis Triad, Heidelberg Pouchitis Activity Score and Pouchitis Disease Activity Index (PDAI). In a systematic review that included four randomized trials evaluating five agents for the treatment of acute pouchitis, ciprofloxacin was more effective at inducing remission as compared with metronidazole. Rifaximin was not more effective than placebo, while budesonide enemas and metronidazole were similarly effective for inducing remission of acute pouchitis. Patients with pouchitis relapsing more than three times per year are advised maintenance therapy, and guidelines recommend ciprofloxacin or the probiotic VSL#3. In patients with antibiotic-refractory pouchitis, secondary factors associated with an antibiotic-refractory course should be sought and treated. In this review, we will discuss the prevention and management of pouchitis in Ulcerative Colitis patients.


Author(s):  
Jonathan Pastrana Del Valle ◽  
Grace C. Lee ◽  
Jose Cataneo Serrato ◽  
Joseph D. Feuerstein ◽  
Liliana Grigorievna Bordeianou ◽  
...  

2021 ◽  
Author(s):  
Paul T. Kröner ◽  
Amit Merchea ◽  
Dorin Colibaseanu ◽  
Michael F. Picco ◽  
Francis A. Farraye ◽  
...  

2009 ◽  
Vol 52 (2) ◽  
pp. 187-192 ◽  
Author(s):  
Stefan D. Holubar ◽  
David W. Larson ◽  
Eric J. Dozois ◽  
Jirawat Pattana-arun ◽  
John H. Pemberton ◽  
...  

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