2005 Abstracts: Chronic Pouchitis Following Ileal Pouch Anal Anastomosis for Ulcerative Colitis
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Chronic Pouchitis Following Ileal Pouch Anal Anastomosis for Ulcerative Colitis
Matthias Turina, Connie J. Pennington, Jennifer Kimberling, Susan Galandiuk, Price Institute of Surgical Research, Louisville, KY
Background: Proctocolectomy with ileal pouch anal anastomosis (IPAA) is the surgical treatment of choice for severe ulcerative colitis (UC). Chronic pouchitis remains a clinically frequent, poorly understood complication in up to 30% of cases, and often requires chronic antibiotic and antidiarrheal treatment to control symptoms.
Hypothesis: Chronic pouchitis following IPAA for UC adversely affects pouch function and quality of life. We hypothesized that its occurrence may be predicted by distinct pre- and/or perioperative parameters, allowing for identification of patients at risk and perhaps choice of another procedure (proctocolectomy and ileostomy). Patients and Methods: 77 consecutive UC patients who underwent IPAA over a 10-year period were retrospectively analyzed by chart review, Cleveland Clinic Global Quality of life questionnaires, and telephone interview. Pouchitis was diagnosed by the presence of watery diarrhea for >48 hours, abdominal pain and/or fever, along with endoscopic and histologic inflammation; chronic pouchitis was identified by the need for long-term oral antibiotic therapy. Using bivariate comparison, clinical predictors for the occurrence of chronic pouchitis (e.g., smoking history, body mass index, or ASA score) were sought, and postoperative data were analyzed with regard to functional results and quality of life. Results: 21 of 77 patients (27 %) experienced chronic pouchitis following IPAA after a mean follow-up period of 4 years, whereas 56 patients had occasional or no such episodes. The occurrence of chronic pouchitis could not be attributed to any of the variables assessed. Patients with chronic pouchitis had more frequent bowel movements (7.8/day vs. 6.5 in controls, p<0.05) and complained of more frequent fecal incontinence (33% vs. 9% in controls, p<0.05), and abdominal pain (p=0.02). Antibiotic and antidiarrheal therapy reduced the number of bowel movements in chronic pouchitis patients, but subjective quality of life remained significantly decreased (p<0.01). Conclusion: Contrary to our hypothesis, the occurrence of chronic pouchitis following IPAA is not predicted by any clinical parameter. Patients suffering from chronic pouchitis experienced more abdominal pain and a higher frequency of bowel movements and episodes of fecal incontinence. Chronic antibiotic and antidiarrheal therapy was able to improve bowel frequency, but subjective quality of life remained diminished relative to non-pouchitis patients.
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