Objective To evaluate the safety of total proctocolectomy (TPC) + ileal pouch anal anastomosis (IPAA) and postoperative pouch and sexual function in ulcerative colitis (UC) patients. Methods Clinical data of UC patients undergoing TPC+IPAA from March 2011 to January 2018 in our hospital were retrospectively collected. Postoperative follow-up ended in June 2018. Patients were divided into subgroups according to whether developing postoperative complications, pouch function disorder (incontinence or defecation >8 times/d) and sexual function disorder (disorder of erection, sexual evocation or ejaculation) . Chi-square test and logistic regression were used to analyze the risk factors for postoperative complications, pouch function and sexual function. Results A total of 43 UC patients receiving TPC+IPAA were enrolled and 45 cases of postoperative complications were found in 21 patients including pouchitis (16 cases, 35.6%) , anastomotic stricture (7 cases, 15.6%) and anastomotic leakage (6 cases, 13.3%) without severe complication. The proportion of 3-stage IPAA in patients without complication was significantly higher as compared to those with complication (59.1% vs. 23.8%, P = 0.019) , and 3-stage IPAA procedure decreased complication in UC surgery (OR = 0.216, 95% CI: 0.058-0.806, P<0.05) . Twenty-four patients completed stoma closure and their defecation and sexual function were evaluated after (33.29±22.37) months, of whom 9 cases (37.5%) developed pouch dysfunction and 8 cases (33.3%) developed sexual dysfunction. No significant differences of preoperative glucocorticoid treatment, infliximab treatment, surgical method, surgical timing and IPAA stage were found between with and without pouch dysfunction groups, with and without sexual dysfunction groups. Conclusions TPC+IPAA is feasible and effective in treating UC patients. Most UC patients can maintain normal defecation function and sexual function after surgery. Three-stage IPAA is a protective factor for postoperative complication of TPC+IPAA. Key words: Inflammatory bowel disease; Ulcerative colitis; Ileal pouch anal anastomosis; Total proctocolectomy

Pyloric type metaplasia (PYME) as evidence of chronic mucosal damage, is one of the main histopathological findings for diagnosing Crohn's Disease (CD) in terminal ileum biopsies, according to the latest guidelines but still frequently underdiagnosed in routine pathology. Foveolar metaplasia (FOME) changes in mucosa, another aspect of the chronic post -inflammatory Ulcer Associated Cell Lineage (UACL), have only been reported in a few cases. However, their clinical significance has not been investigated in depth except in pouchitis. The aim of this study was to investigate the importance of meticulous study of terminal ileum biopsies for the recognition of PYME/FOME as an adjunct finding helpful for the diagnosis of CD. In the present study, two experienced gastrointestinal pathologists, have reviewed 105 terminal ileum biopsies from 105 patients with CD, using a protocol of 15 sections on average per biopsy. In 21% (22/105) of cases PYME was recognized and in 4% (4/105) FOME was also present. PYME/FOME had not been detected in 83% of these cases in the original reports. FOME was also identified in terminal ileum biopsies, a feature not reported previously in CD. Conclusively, PYME/FOME can be easily missed in terminal ileum biopsies from patients with suspected or known CD unless a meticulous study of the histologic material is carried out combined with awareness of the pathologist about its importance.

Pouchitis is the common complication of modest to severe ulcerative colitis patients after ileal pouch-anal anastomosis and mainfest itself with increased stool frequency, rectal bleeding, abdominal cramping and fever. The pathogenesis of pouchitis remains incompletely elucidate, however, most researchers believe that the change of the pouch flora (disorder) would lead to the immune activation and inflammation. Therefore probiotics treatment in pouchitis against in the flora disorder is concerned by many researchers both at home and board. The pathogenesis of pouchitis and probiotics treatment was as follows. Key words: Digestive system; Therapy; Pouchitis; Ileal pouch-anal anastomosis; Probiotics

Pouchitis is the most frequently occurring complication of ileal pouch–anal anastomosis for ulcerative colitis and is commonly treated with antibiotics

Purpose. Early operation is recommended for patients with adenomatous polyposis coli because cancer will develop in 100% of patients if untreated. Surgery is reserved for treating complications of ulcerative colitis (UC). This is a retrospective analysis of surgical results of restorative protocolectomy with ileal pouch anal anastomosis (IPAA), performed by a single surgeon (TCH) for patients with adenomatous polyposis coli and ulcerative colitis in a period of 27 years. Materials and Methods. A total of 44 patients with adenomatous polyposis coli and two patients with juvenile polyposis coli were operated from 1983 to 2010. Twenty-three patients were male, and 23 patients were female. Age ranged from 11 to 58 years old (an average age of 34.2 years old). Twenty-two cases of adenomatous polyposis coli received restorative proctocolectomy with IPAA. A total of 44 patients with ulcerative colitis were operated by the same surgeon. Twenty four were male and 20 were female. Age ranged from 16 to 74 years (an average age of 46.4 years old). Restorative proctocolectomy with IPAAwas performed for 25 patients. Results. In the patients with adenomatous polyposis coli, four patients were re-explored postoperatively for postoperative complications, a patient did not have the ileostomy closed, a patient died of metastatic cancer, and a patient died of non-cancer cause. 19 patients (86%) had good function of pouch. Complications of the patients with UC included intestinal obstruction in five patients (20%), wound infection in five patients (20%), rectovaginal fistula in three patients (12%), pelvic abscess in two patients (8%), pouch perforation in one patient (4%) and pouchitis in five patients (20%). Six patients had pouch removed for various complications. 16 patients (64%) had good function of pouch. Conclusion. Restorative proctocolectomy with IPAAis not a perfect operation, but could offer reasonable good quality of life among 86% of our patients with adenomatous polyposis coli. Only 64% of our patients with ulcerative colitis had good pouch function after restorative proctocolectomy with IPAA. Although IPAAmay offer fair to good quality of life, the price is high while such an operation was offered to the patients especially in patients with ulcerative colitis.

Intestinal microbiota plays an important role in gut metabolism, defense against environmental pathogens, motility and immune system regulation. Microbiota is gradually aquired from the environment during and after delivery, with several factors, such as feeding habits, disease and antibiotic treatment, importantly influencing its composition. Growing awareness about the importance of the intestinal microbiota for the host physiologic processes and health has led to development of different strategies how to influence its composition and function. Probiotics, specific live microorganisms which when ingested in sufficient amount can promote health benefit to the host, and prebiotics, nondigestible food ingredients that benefit the host by selectively stimulating the favorable growth and/or activity of a limited number of health-promoting bacteria, have been increasingly used in the last decades. They exert their beneficial effects through three main mechanisms: by changing gut ecology, affecting the intestinal mucosal barrier, and by modulating the immune response. The efficacy of pro- and prebiotics in clinical practice has been extensively studied. The results of clinical studies with the specific strain or strains in a defined dose and vehicle should not be extrapolated to the use of other products. There is strong scientific evidence for the use of specific probiotics in acute gastroenteritis, antibiotic-associated diarrhea, prevention and treatment of atopic dermatitis, prevention of relapses of ulcerative colitis and pouchitis, as well as enhancing immune response, and some evidence of efficacy in prevention of necrotizing enterocolitis, treatment of Clostridium difficile- associated diarrhea, active ulcerative colitis, and functional gastrointestinal disorders.

KEY MESSAGE The high rate of remission maintenance seen in many clinical trials of probiotics for pouchitis prevention has not been replicated in studies conducted under ordinary practice conditions.

Pouchitis is a common and well-known complication of total proctocolectomy and ileoanal pouch anastomosis (IPAA) for inflammatory bowel disease. In some but not all studies, positivity for antineutrophil cytoplasmic antibody (ANCA) has been associated with an increased risk for pouchitis. A link between the anti– Saccharomyces …

Randomized Controlled Trials in Pouchitis

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for patients with medically refractory ulcerative colitis (UC) or UC with dysplasia and for the majority of patients with familial adenomatous polyposis. However, UC patients with IPAA are susceptible to a number of inflammatory and non-inflammatory sequelae, such as pouchitis, Crohn disease(CD) of the pouch, cuffitis, and irritable pouch syndrome, in addition to common surgery-associated complications, which adversely affect the surgical outcome and compromise patient's health-related quality of life. Pouchitis is the most frequent long-term complication of IPAA in patients with UC, with a cumulative prevalence of up to 50%. Pouchitis may be classified based on the etiopathogenesis into "idiopathic" and "secondary" types and the management is often different. Pouchoscopy is the most important tool for the diagnosis and differential diagnosis in patients with pouch dysfunction. Antibiotic therapy is the main stay of treatment for active pouchitis. Some patients may develop dependency on antibiotics, requiring long-term maintenance therapy. While management of antibiotic-dependent or antibiotic-refractory pouchitis has been challenging, secondary etiology for pouchitis should be evaluated and modified, if possible.

回腸嚢炎は潰瘍性大腸炎(UC)に対する大腸亜全摘・回腸嚢肛門(管)吻合術後に回腸嚢に起こる非特異性炎症である・外科治療成績の向上に伴いクローズアップされてきた病態で,病因は未だ不明であるが,UCの病態と関連があり,腸内細菌の関与が濃厚である.抗菌剤が有効で,多くは一過性であるが,一部に難治例があり,病因・病態の解明とより有効な治療の開発が待たれる.

IgG4-associated Pouchitis

Which therapies are advisable in pouchitis?

U ntil now few small placebo-controlled trials have been carried out and, as a consequence, the medical treatment of pouchitis is still widely empiric. AntibioticsAntibiotics are the mainstay of treatment.Usually ciprofloxacin and metronidazole represent the most common first therapeutic approach, and most patients with acute pouchitis respond quickly to administration of 1 g/day.In a small randomized clinical trial, ciprofloxacin 1 g/day and metronidazole 20 mg/kg/day were given for 2 weeks.Both drugs significantly reduced the total Pouchitis Disease Activity Index (PDAI) scores; however, ciprofloxacin led to a greater degree of reduction in total PDAI score, to a greater improvement in symptoms and endoscopic scores, and furthermore, was better tolerated (33% of metronidazole-treated patients reported adverse effects such as nausea, vomiting, abdominal discomfort, headache, skin rash, dysgeusia, and peripheral neuropathy, compared with none of ciprofloxacin-treated patients). 1Therefore, ciprofloxacin should be considered the first-line therapy for acute pouchitis.

Managing Pouchitis

Managing Pouchitis

SirWe are pleased to see that our review article on 'Dysbiosis and pouchitis' achieved the desired aim and stimulated thought and debate amongst our colleagues in London.However, they appear to have missed the point of the algorithm that was constructed 'to aid management and suggest a structured approach for future research' as stated, in bold, at the start of the article.Further, we would take issue with a number of points raised by Dr McLaughlin et al.Pre-pouch ileitis is a recognized but not well worked-out condition as described by Bell et al. 1 .Afferent limb inflammation and ulcers are associated

We and others have reported the use of tacrolimus in refractory inflammatory bowel disease (IBD). Little is known about its long-term efficacy and safety. In this retrospective, observational single center study the charts of 53 adult patients with steroid-dependent (n = 18) or steroid-refractory (n = 35) IBD, Crohn's disease (CD) (n = 11), ulcerative colitis (UC) (n = 40), or pouchitis (PC) (n = 2) were reviewed. Tacrolimus (0.1 mg/kg body weight per day) was administered orally in all and initially intravenously in 2 patients (0.01 mg/kg body weight per day), aiming for serum trough levels of 4-8 ng/mL. Forty-one of 53 (77.1%) patients were receiving concomitant azathioprine. The mean treatment duration was 25.2 +/- 4.6 SD months (0.43-164 months). Patients were followed for a mean of 39 +/- 4.1 SD months (5-164 months). Response was evaluated using a modified clinical activity index (M-CAI). Thirty-one UC (78%), 10 CD (90.1%), and both PC (100%) patients experienced an immediate clinical response or went into remission at 30 days. A statistically significant drop on the M-CAI was documented for UC and CD patients. Nine UC patients (22.5%) underwent colectomy between 1.6 and 41.3 months following initiation. Mean colectomy-free survival was 104.8 +/- 15.5 (95% CI 74.4-135.2) months (limited to 164.4 months). Cumulative colectomy-free survival was estimated 56.5% at 43.8 months. Steroids were reduced or discontinued in 40 of 45 UC and CD patients (90%) taking steroids. Side effects included a temporary rise of creatinine (n = 4, 7.6%), tremor or paresthesias (n = 5, 9.4%), hyperkalemia (n = 1, 1.9%), hypertension (n = 1, 1.9%), and opportunistic infections (n = 2, 3.8%). Long-term tacrolimus therapy appears safe and effective in refractory IBD.

Maintaining remission in patients with refractory or treatment-resistant pouchitis is problematic. In this partially manufacturer-supported study,

目的・方法:潰瘍性大腸炎術後のpouchitisについて,診断,治療上の問題点を検討した.Pouchitisの診断にはPouchitis Disease Activity Index (PDAI) scoreと厚生省診断基準案を併用した.厚生省診断基準案の内視鏡所見で中等度以上に該当した症例に対して抗生剤を投与し,前後の臨床症状,内視鏡所見について検討した.結果:PDAI scoreと厚生省診断基準案は同様の結果であり,組織所見なしでも診断,重症度判定は可能であった.Pouchitis症例では排便回数は内視鏡所見とよく相関し,治療後有意に減少した.