GASTROENTEROLOGY ARTICLE OF THE WEEK
February 23, 2006
Shen B, Fazio VW, Remzi FH. Clinical approach to diseases of the ileal pouch-anal anastomosis. Am J Gastroenterol 2005;100:2796-2807.
1. Possible factors that increase the likelihood of developing pouchitis include
a. Reason for the surgery
b. Presence of sclerosing cholangitis
c. Use of NSAIDs
d. Dose of prednisone and immunosuppression post-op
e. Composition of the anaerobic flora in the pouch
f. Smoking status of the patient
2. Possible causes of antibiotic-refractory pouchitis include
a. use of NSAIDs
b. concurrent C. difficile infection
c. CMV infection
d. recurrent UC in the ileal pouch
e. celiac disease
f. Crohn’s disease
3. Clinical clues to the development of Crohn’s pouchitis include
a. symptoms in a patient who currently smokes
b. Presence of nausea, vomiting, fever, weight loss
c. History of backwash ileitis
d. Perianal fistulae
e. iron deficiency anemia
4. Features typical of irritable pouch syndrome include
a. lower volume threshold for stool sensation
b. more frequent referred abdominal pain when the pouch was distended
c. poor compliance of the pouch
d. increased likelihood of endoscopic inflammation
e. presence of increased frequency of BM, cramping, perianal or pelvic
discomfort with normal endoscopic exam of the pouch
True or False
5. Pouchitis is as common among patients undergoing colectomy for familial adenomatous polyposis coli as for those undergoing surgery for U.C.
6. A practical approach to suspected pouchitis includes endoscopy without biopsy followed by treatment trial if endoscopy is abnormal
7. Patients with antibiotic-dependent pouchitis should be tested for possible small bowel bacterial overgrowth.
8. VSL#3, a probiotic, may be useful in preventing the first episode of pouchitis as well as preventing relapse
9. Antibiotic-responsive pouchitis is defined as <4 episodes per year that promptly respond to a 2 week course of antibiotics