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Gut. 1993 November; 34(11): 1539–1542.
PMCID: PMC1374418

Refractory pouchitis: does it reflect underlying Crohn's disease?

Abstract

Typical 'pouchitis' is a well recognised complication of ileal pouches in ulcerative colitis. Infrequently, a refractory pouchitis (RP) presents with certain clinical, endoscopic, and pathological features resembling Crohn's disease and is often ascribed to misdiagnosis of the initial colitis. To test that hypothesis and to identify risk factors for RP, this study reviewed cases of presumed ulcerative colitis with ileal pouches constructed at The Mount Sinai Hospital between 1973 and 1986. Twenty four cases with RP (16 Kock pouches and eight pelvic pouches) and 21 controls were compared for eight clinical variables. The original colectomy slides from 15 RP and 18 control cases were reviewed blindly, classified into five histological categories (corresponding to definite ulcerative colitis, definite Crohn's disease, and three indeterminate groups), and scored for 23 histological features. There were no significant clinical differences between RP and control cases except for more frequent extraintestinal manifestations (38% v 5%) and male preponderance (79% v 43%) in RP. There were also no significant differences between the distributions of RP cases and controls among the five histological categories or in the 23 histological features studied. Refractory pouchitis therefore does not seem to reflect underlying Crohn's disease, but may be linked to immunological mechanisms that are manifested clinically as extraintestinal complications.

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Selected References

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  • Dozois RR, Goldberg SM, Rothenberger DA, Utsunomiya J, Nicholls RJ, Cohen Z, Hultén LA, Moskowitz RL, Williams NS. Restorative proctocolectomy with ileal reservoir. Int J Colorectal Dis. 1986 Jan;1(1):2–19. [PubMed]
  • Pemberton JH, Kelly KA, Beart RW, Jr, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis. Long-term results. Ann Surg. 1987 Oct;206(4):504–513. [PubMed]
  • Tytgat GN, van Deventer SJ. Pouchitis. Int J Colorectal Dis. 1988 Nov;3(4):226–228. [PubMed]
  • Madden MV, Farthing MJ, Nicholls RJ. Inflammation in ileal reservoirs: 'pouchitis'. Gut. 1990 Mar;31(3):247–249. [PMC free article] [PubMed]
  • Shepherd NA, Jass JR, Duval I, Moskowitz RL, Nicholls RJ, Morson BC. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol. 1987 Jun;40(6):601–607. [PMC free article] [PubMed]
  • Nilsson LO, Kock NG, Lindgren I, Myrvold HE, Philipson BM, Ahrén C. Morphological and histochemical changes in the mucosa of the continent ileostomy reservoir 6--10 years after its construction. Scand J Gastroenterol. 1980;15(6):737–747. [PubMed]
  • Becker JM, Raymond JL. Ileal pouch-anal anastomosis. A single surgeon's experience with 100 consecutive cases. Ann Surg. 1986 Oct;204(4):375–383. [PubMed]
  • Fleshman JW, Cohen Z, McLeod RS, Stern H, Blair J. The ileal reservoir and ileoanal anastomosis procedure. Factors affecting technical and functional outcome. Dis Colon Rectum. 1988 Jan;31(1):10–16. [PubMed]
  • Kock NG, Myrvold HE, Nilsson LO, Philipson BM. Continent ileostomy. An account of 314 patients. Acta Chir Scand. 1981;147(1):67–72. [PubMed]
  • Hultén L, Svaninger G. Facts about the Kock continent ileostomy. Dis Colon Rectum. 1984 Aug;27(8):553–557. [PubMed]
  • Goldman SL, Rombeau JL. The continent ileostomy: a collective review. Dis Colon Rectum. 1978 Nov-Dec;21(8):594–599. [PubMed]
  • Järvinen HJ, Mäkitie A, Sivula A. Long-term results of continent ileostomy. Int J Colorectal Dis. 1986 Jan;1(1):40–43. [PubMed]
  • Ojerskog B, Kock NG, Nilsson LO, Philipson BM, Ahrén C. Long-term follow-up of patients with continent ileostomies. Dis Colon Rectum. 1990 Mar;33(3):184–189. [PubMed]
  • Everett WG. Experience of restorative proctocolectomy with ileal reservoir. Br J Surg. 1989 Jan;76(1):77–81. [PubMed]
  • Pescatori M, Mattana C, Castagneto M. Clinical and functional results after restorative proctocolectomy. Br J Surg. 1988 Apr;75(4):321–324. [PubMed]
  • Rauh SM, Schoetz DJ, Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Pouchitis--is it a wastebasket diagnosis? Dis Colon Rectum. 1991 Aug;34(8):685–689. [PubMed]
  • Zuccaro G, Jr, Fazio VW, Church JM, Lavery IC, Ruderman WB, Farmer RG. Pouch ileitis. Dig Dis Sci. 1989 Oct;34(10):1505–1510. [PubMed]
  • Lohmuller JL, Pemberton JH, Dozois RR, Ilstrup D, van Heerden J. Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg. 1990 May;211(5):622–629. [PubMed]
  • Klein K, Stenzel P, Katon RM. Pouch ileitis: report of a case with severe systemic manifestations. J Clin Gastroenterol. 1983 Apr;5(2):149–153. [PubMed]
  • Pezim ME, Pemberton JH, Beart RW, Jr, Wolff BG, Dozois RR, Nivatvongs S, Devine R, Ilstrup DM. Outcome of "indeterminant" colitis following ileal pouch-anal anastomosis. Dis Colon Rectum. 1989 Aug;32(8):653–658. [PubMed]
  • Gustavsson S, Weiland LH, Kelly KA. Relationship of backwash ileitis to ileal pouchitis after ileal pouch-anal anastomosis. Dis Colon Rectum. 1987 Jan;30(1):25–28. [PubMed]
  • Hyman NH, Fazio VW, Tuckson WB, Lavery IC. Consequences of ileal pouch-anal anastomosis for Crohn's colitis. Dis Colon Rectum. 1991 Aug;34(8):653–657. [PubMed]
  • Nasmyth DG, Johnston D, Godwin PG, Dixon MF, Smith A, Williams NS. Factors influencing bowel function after ileal pouch-anal anastomosis. Br J Surg. 1986 Jun;73(6):469–473. [PubMed]
  • Nicholls RJ, Belliveau P, Neill M, Wilks M, Tabaqchali S. Restorative proctocolectomy with ileal reservoir: a pathophysiological assessment. Gut. 1981 Jun;22(6):462–468. [PMC free article] [PubMed]
  • Brandberg A, Kock NG, Philipson B. Bacterial flora in intraabdominal ileostomy reservoir. A study of 23 patients provided with "continent ileostomy". Gastroenterology. 1972 Sep;63(3):413–416. [PubMed]
  • Luukkonen P, Valtonen V, Sivonen A, Sipponen P, Järvinen H. Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis. Dis Colon Rectum. 1988 Nov;31(11):864–867. [PubMed]
  • Sachar DB. 1989 Henry Baker lecture. Inflammatory bowel disease: back to the future. Am J Gastroenterol. 1990 Apr;85(4):373–376. [PubMed]

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