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Laparoscopic Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Rajat Srivastava
Pouchitis is an inflammatory condition of the ileal pouch reservoir of an ileal pouch-anal anastomosis. Among patients who have undergone IPAA, the reported incidence of pouchitis ranges from 23% to 59% [20]. Patients who have undergone an IPAA for UC have a higher incidence of pouchitis as compared to patients with FAP. The pathogenesis of pouchitis is unclear, but it is hypothesized to result from an abnormal immune response to altered luminal and/or mucosal bacteria in genetically susceptible hosts. The pathogenesis is multifactorial and genetic factors, changes in gut microbiota, and abnormal mucosal immunity play an important role. Pouchitis is not an isolated disease entity, it likely represents a disease spectrum ranging from acute antibiotic-responsive pouchitis to chronic antibiotic-refractory pouchitis (CARP). Several other pouch disorders have been recognized, such as the irritable pouch syndrome and anismus (anorectal dysfunction) (Table 16.2) [14].
Colorectal Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Jennie Grainger, Samson Tou, Steve Schlichtemeier, William Speake, Fung Joon Foo, Frank McDermott
What is pouchitis and its causes?Pouchitis is an inflammatory response to changes within the pouch.Aetiology is unknown.Thought to be triggered by changes in the intra luminal bacteria within the pouch.20%–50% will suffer pouchitis at some point.Characterised by stool frequency, urgency, liquid stool, abdominal pain and fever.More common in smokers.Diagnosis based on history and findings at endoscopy.Histology may be needed for confirmation.
Pouch Dysfunction in Colitis
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Mariangela Allocca, Silvio Danese, Tom Øresland, Michael R.B. Keighley
Pouchitis was first reported by Kock in 1977,8 who observed it in the continent ileostomy. Later, after introducing IPAA in the 1980s, a similar inflammatory condition was observed in the pelvic pouch after ileo anal anastomosis.9 The clinical manifestation of pouchitis can include an increased number and looser consistency of bowel movements, urgency, incontinence, abdominal cramps and rectal bleeding.
Fecal calprotectin as an indicator in risk stratification of pouchitis following ileal pouch–anal anastomosis for ulcerative colitis
Published in Annals of Medicine, 2023
Rui-Bin Li, Chun-Qiang Li, Shi-Yao Zhang, Kai-Yu Li, Zhi-Cheng Zhao, Gang Liu
Pouchitis is a nonspecific inflammatory disease of the ileal pouch. The main diseases that require IPAA are familial adenomatous polyposis and UC [8]. Patients with UC are more likely to develop pouchitis than are patients with familial adenomatous polyposis [9], and the reason may be related to the abnormal autoimmune status of patients with UC. The main inflammatory indicators reflecting the inflammatory status in patients with UC include the WBC count, CRP concentration, ESR, and FC concentration [10,11]. The blood inflammatory indicators in this study included the WBC count, neutrophil percentage, CRP concentration, and ESR. It is evident that the CRP concentration and ESR are more valuable than the WBC count. Matalon et al. [12] evaluated 71 patients with UC who developed pouchitis and found that the CRP concentration was significantly correlated with the PDAI score (r = 0.584, p < 0.001). Lu et al. [13] obtained a similar result.
Adalimumab in the treatment of chronic pouchitis. A randomized double-blind, placebo-controlled trial
Published in Scandinavian Journal of Gastroenterology, 2019
Mie Dilling Kjær, Niels Qvist, Inge Nordgaard-Lassen, Lisbet Ambrosius Christensen, Jens Kjeldsen
The etiology of pouchitis is unknown, but it is believed that microbiologic, genetic and immunologic factors play an important role. An alteration in the bacteria flora has been demonstrated in pouchitis patients, with an increasing total number of bacteria, but without reaching the normal level in colon [1,5,7]. However, no correlation between the concentration of bacteria and the degree of acute inflammation has been shown [7]. Conventional therapy is directed toward changing the bacterial flora, mainly with antibiotics and more recently with probiotics [8,9]. Furthermore, it is known that dysregulated immune responses to fecal microbiota, including increased production of tumor necrosis factor-α (TNF-α), play a role in the pathogenesis of UC. Some studies have found increased TNF-α levels in the mucosa of patients with pouchitis [10], whereas others did not [11]. TNF-α is considered to be a pivotal cytokine that mediates many of the inflammatory signals in inflammatory bowel disease. This is exploited in the treatment of UC, and biological therapy with anti-TNF-α such as Infliximab and Adalimumab has been introduced in the treatment of chronic refractory pouchitis.
Paediatric inflammatory bowel disease: review with a focus on practice in low- to middle-income countries
Published in Paediatrics and International Child Health, 2019
Anthony Mark Dalzell, Muhammad Eyad Ba’Ath
Mortality following emergency colectomy has declined significantly in recent decades but protracted medical therapy can lead to patients presenting for surgery in a poorer state of health, resulting in a poorer post-operative outcome [83]. The complication rate after resectional surgery for IBD can be up to 57% for CD and 31% for UC. About 50% of children with CD will require a second operation at some point [78]. The functional outcome after J-pouch reconstruction in children with UC is generally good. However, the overall failure rate of attempted reconstructive surgery is up to 24%, largely owing to the poor results of straight ileo-anal anastomosis. Median daily stool frequency after J-pouch surgery is five (range 3–15) [80]. Most patients with UC who undergo pouch surgery will develop pouchitis. Risk factors for pouchitis include younger age at diagnosis, shorter UC duration before surgery and refractory disease. This suggests that the processes determining UC severity may be similar to those causing pouchitis [84].