GASTROENTEROLOGY ARTICLE OF THE WEEK
April 1, 2004
Mahadevam U, Sandborn WJ. Diagnosis and management of pouchitis. Gastroenterology 2003;124:1636-50
1. Pouchitis
a. risk of developing pouchitis is about 45% at 10 years after IPAA
b. the incidence is much lower when the pouch is created for treatment of FAP
c. when refractory to therapy could be caused by CMV T
d. can be present despite a normal endoscopic and histologic exam
e. severe pouchitis occurs in about 5% of people operated
f. incidence of pouchitis is increased in patients with PSC
g. the etiology of pouchitis is not known
2. After pouchitis
a. the average number of bowel movements is about 6
b. fecal incontinence occurs in <5% of individuals
c. quality of life in is usually lower than the average population
d. female fertility rates are lower
3. Therapy of pouchitis
a. drug of choice for the initial treatment of pouchitis is ciprofloxacin 500mg bid for 7-
10 days
b. for chronic pouchitis maintenance with daily or every 3 days antibiotics may help
c. mesalamine has been found to be helpful in most patients with pouchitis
d. corticosteroids may be useful based on anecdotal experience
e. allopurinol is helpful in refractory patients
f. fiber is an important component of the treatment of pouchits
True or False
4. Ulceration and/or inflammation of the terminal ileum above the pouch is consistent with the diagnosis of pouchitis.
5. Histologic findings of pouchitis are diagnostic for this condition.
6. Pouchitis may be associated with extraintestinal manifestations.
7. The severity of UC prior to surgery is not predictive of the development of pouchitis
8. Drug of choice for the initial treatment of pouchitis is ciprofloxacin 500mg bid for 7-10 days
9. Smoking worsens pouchitis
10. Probiotics may help maintain a remission
11. If a fistula is present in the pouch, the most likely etiology of “pouchitis” is recurrent Crohn’s disease.
12. Endoscopic surveillance for dysplasia is recommended for
a. all patients who undergo IPAA
b. all patients with an ilestomy as a result of total colectomy for UC
c. patients with chronic pouchitis
d. patients who had dysplasia in the resected colon
e. patients with UC, and type C mucosa in the pouch 1 year after surgery