T wenty to thirty percent of patients with ulcerative colitis (UC) ultimately require surgical intervention due to escalating disease including bleeding, obstruction, perforation, or dysplasia. 1 Total proctocolectomy with construction of an ileal pouch anal anastomosis (IPAA) has become the standard of care for patients with UC who require removal of the colorectum. This surgery involves abdominal colectomy and construction of an ileal pouch that is anastomosed to the anus. 2 This method takes advantage of the fact that ulcerative colitis is a mucosal disease limited to the rectum and colon, and permits the surgeon to leave intact the rectal muscular cuff and anal sphincters.
The majority of patients with UC who undergo IPAA report improved quality of life after surgery. 2 However, a growing number of complications can impact adversely on the long-term outcome of these patients. The most common and widely reported of these complications is a nonspecific inflammation of the ileal pouch, a condition referred to as "pouchitis." Pouchitis is manifest clinically as a syndrome of watery, frequent diarrhea or hematochezia, accompanied by urgency, incontinence, abdominal cramping, malaise, and fever. 3 Other complications of IPAA include the subsequent development of Crohn's disease (CD) in the pouch, cuffitis (inflammation in the rectal cuff), and irritable pouch syndrome (symptoms of abdominal pain and/or diarrhea in the absence of ileal pouch mucosal inflammation).
Several retrospective epidemiologic studies have attempted to identify risk factors placing patients at risk for the development of pouchitis. 4 -7 This study by Shen et al, however, is unique in that it is a prospective analysis. They examined both inflammatory and noninflammatory disease entities of the pouch including antibiotic-dependent pouchitis, antibiotic-refractory pouchitis, CD of the pouch, cuffitis, and irritable pouch syndrome (IPS). The aim of the study was to identify risk factors that may contribute to the development of these ileal pouch diseases.
Two hundred and forty consecutive adult patients who underwent IPAA surgery for UC were recruited from the Pouchitis Clinic at the Cleveland Clinic. These patients were