Objective:
To determine the incidence timing and effectiveness of treatment of symptomatic pouchitis following restorative proctocolectomy with ileal J-pouch anal anastomosis.
Design:
A cohort analytical study.
Setting:
University hospitals, a tertiary referral center; all subjects entered into the study followed up for a minimum of 12 months (mean follow-up, 40 months).
Patients:
One hundred four consecutive patients undergoing restorative proctocolectomy with ileal J-pouch anal anastomosis for either ulcerative colitis (n=97) or familial adenomatous polyposis (n=7) between June 1986 and December 1994.
Interventions:
Patients with symptomatic pouchitis were treated with either oral metronidazole or ciprofloxacin.
Outcomes:
Diagnosis of pouchitis was determined by clinical symptoms and confirmed with endoscopy. Response to oral antibiotics was determined by resolution of symptoms.
Results:
Fifty-two patients (50%) experienced at least 1 episode of pouchitis. The first episode of pouchitis occurred within the first 12 months after restoration of intestinal continuity in 56% of the cases. In 2 patients it occurred after 30 months. Response to antibiotic treatment was 96%. Two thirds of patients had multiple episodes. Chronic pouchitis occurred in 6 patients, necessitating pouch removal in 2.
Conclusions:
The incidence of pouchitis after ileal J-pouch anal anastomosis is approximately 50% with two thirds of these patients having multiple episodes. Chronic pouchitis occurs in a minority of patients. In chronic pouchitis, the risk of pouch loss is substantial.(Arch Surg. 1996;131:497-502)