Long-Term Followup of Patients with Active J-Reservoirs after Restorative Proctocolectomy for Ulcerative Colitis with regard to Reservoir Function, Mucosal Changes, and Quality of Life

Ola Røkke,Torill Olsen,Gitta Erika Turowski,Sølvi-May Ristesund,Knut Iversen,Geir Egil Eide

doi:10.5402/2011/430171

Abstract

Objective. Study the functional results and mucosal changes in the ileal pouch after restorative proctocolectomy with J-reservoir for ulcerative colitis. Material and Methods. Followup study of 125 patients with J-reservoir with one disease-specific- and one general (SF-36) quality of life-questionnaire, rectoscopy with biopsies, and stool samples to evaluate inflammation, dysplasia, presence of Helicobacter pylori and calprotectin level. Results. Fourteen J-reservoirs were removed or deactivated, leaving 111 patients for followup. The followup time was 6.8 (1–15) years. 87.4% of the patients were satisfied. 93.1% had some kind of functional restriction: food- (75.5%), social- (28.9%), physical- (37%) or sexual restriction (15.3%). 18.6% had often or sometimes faecal incontinence. Low daytime faecal frequency was associated with good quality of life. 13 patients (12.6%) had a less favourable result. There was no pouch-dysplasia. Calprotectin levels were increased in patients with visible pouch inflammation or history of pouchitis. HP was diagnosed by RUT in 42.3%, but was not associated with inflammation or pouchitis. Conclusions. Most patients were satisfied with the J-reservoir in spite of a high frequency of various restrictions. 12.6% (13 patients) had a less favourable functional result, partly due to a high frequency of defecations, pain, pouchitis and inflammation.

Highlights

Surgical treatment of ulcerative colitis may be indicated when medical treatment fails
A total of 125 consecutive patients with ulcerative colitis treated with restorative proctocolectomy and ileal pouch with the J-reservoir construction [12] from 1988 until 2002 were included in the study
The present study showed a wide spectrum of functional results in patients with the J-reservoir

Summary

Introduction

Surgical treatment of ulcerative colitis may be indicated when medical treatment fails. Restorative proctocolectomy with ileal pouch-anal anatomosis (IPAA) was introduced in 1978 by Parks and Nicholls [1] and is the most commonly used surgical technique. With a successful functional result, these patients avoid a permanent ileostomy and may lead a normal life.Overall patient satisfaction rates of 90–95% have been reported [2, 3], with a quality of life about the same as in patients with ulcerative colitis in remission [4]. There is a clinical observation that the quality of life in patients with reservoirs constitutes a spectrum of functional results. The majority of the patients are satisfied, but a significant minority of these patients has complaints and problems that influence their daily life, with lower quality of life than patients with successful reservoirs. There has been a concern about the risk of dysplasia and malignancy over time from residual rectal mucosa or from the pouch itself, as has been previously reported [9]

Methods

Results

Discussion

Conclusion