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Prospective Study of the Incidence, Timing, and Treatment of Pouchitis in 104 Consecutive Patients After Restorative Proctocolectomy

Roger D. Hurst, MD; Michele Molinari, MD; T. Philip Chung; Michele Rubin, RN; Fabrizio Michelassi, MD
Arch Surg. 1996;131(5):497-502. doi:10.1001/archsurg.1996.01430170043007.
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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)


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