Abstract
Pouchitis is a major long-term complication of the continent ileostomy as well as the ileoanal pouch anastomosis. When diagnosed on the basis of clinical, endoscopic and histologic features, this syndrome has been demonstrated almost exclusively in patients with ulcerative colitis. The clinical course, the endoscopic findings and the histologic abnormalities resemble those of ulcerative colitis. The association with extra-intestinal manifestations further supports the hypothesis that pouchitis represents ulcerative colitis in the small bowel. All ileal reservoirs show bacterial overgrowth, especially of anaerobes. As a response to this altered intraluminal environment chronic inflammation and incomplete colonic metaplasia occur. The efficiency of metronidazole does suggest that bacteriological factors play an important role in the pathogenesis of pouchitis.
Highlights
In the past, a permanent Brooke ileostomy was inevitable for patients requiring a proctocolectomy for either ulcerative colitis or familial adenomatous polyposis
In patients with ulcerative colitis these inflammatory events result in clinical pouchitis
Ulcerative colitis is a condition with the potential of neoplastic change in the large intestine
Summary
A permanent Brooke ileostomy was inevitable for patients requiring a proctocolectomy for either ulcerative colitis or familial adenomatous polyposis. All patients had been successfully treated by catheter drainage and sulphasalazine.[6] Kock suggested that this mucosal inflammation was due to fecal stasis and overgrow th of anaerobic bacteria and advocated the term pouchitis to describe this nonspecific ileitis This syndrome, which occurs in pelvic reservoirs after ileoanal anastomosis, has been described variably as stagnant loop syndrome[7] or mucosal enteritis.[8,9]. Life table analysis of data derived from a register of all patients who have undergone ileoanal anastomosis at the Mayo Clinic revealed a cumulative risk of pouchitis of 31% for patients w ith ulcerative colitis.[21] pouchitis occurs both early and late following reservoir construction, most patients develop their first episode within 2 years postoperatively.[22,28] Approximately half of the patients have only one single episode, whereas the others present tw o or more episodes.[22,24] Rauh et a l.24 reported a preponderance of indeterminate colitis in patients with recurrent episodes of pouchitis. Despite these and other anecdotal reports it is widely accepted that pouchitis is confined to patients operated on for ulcerative colitis
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