✍ Scribed by Bo Shen; Run-Zhou Ni
No coin nor oath required. For personal study only.
D ata on the long-term outcome of restorative procto- colectomy with ileal pouch-anal anastomosis (IPAA) in patients with inflammatory bowel diseaseunclassified (IBDU) or indeterminate colitis (IC) are conflicting in the literature. Pouchitis, particularly antibioticdependent or antibiotic-refractory pouchitis, as well as Crohn's disease (CD) of the pouch, are common longterm adverse sequelae for patients who undergo the IPAA procedure. The risk factors for these inflammatory conditions of the pouch have been extensively investigated. Efforts have been made to delineate the association between the pre-and postoperative diagnosis of IBD and the outcome of IPAA.
The Cedars-Sinai group took advantage of a large prospectively monitored cohort of patients with IPAA and investigated the outcome in patients with a preoperative diagnosis of IBDU or a postoperative diagnosis of IC. The prevalence of acute pouchitis (antibiotic responsive), chronic pouchitis (antibiotic dependent or refractory), or de novo CD (prepouch ileitis or pouch fistula) was assessed. Clinical, endoscopic, and pathologic criteria (including pathologic reports of colectomy specimens) were retrospectively reviewed in all patients to determine whether they had ulcerative colitis (UC), IBDU, or IC according to the Montreal Classification. The study cohort consisted of 334 consecutive patients from 1997 to 2007. Before colectomy, the patients were classified as having UC (N ¼ 237; 71%) or IBDU (N ¼ 97; 29%). After surgery, the patients were reclassified as having UC (N ¼ 236; 71%) or as having IC (N ¼ 98; 29%). Patients were seen for follow-up examinations every 3 months for the first year after stoma closure and yearly thereafter. Only patients monitored for a minimum of 3 months were included in this analysis. After a median follow-up after stoma closure of 26 months, 53 patients (16%) developed acute pouchitis, 37 (11%) developed chronic pouchitis (antibiotic-dependent or antibiotic-refractory pouchitis), and 40 (12%) developed de novo CD. There was no significant difference in the prevalence in acute pouchitis, chronic pouchitis or de novo CD between the UC, IBDU, and IC groups. Based on the results of the univariate analysis, the authors concluded that patients with IBDU or IC may not have an increased risk for development of pouchitis or CD of the pouch.
📜 SIMILAR VOLUMES