Objective
To determine the incidence timing and effectiveness of treatment of symptomatic pouchitis following restorative proctocolectomy with ileal J-pouch anal anastomosis.
Design
A cohort analytical study.
Setting
University hospitals, a tertiary referral center; all subjects entered into the study followed up for a minimum of 12 months (mean follow-up, 40 months).
Patients
One hundred four consecutive patients undergoing restorative proctocolectomy with ileal J-pouch anal anastomosis for either ulcerative colitis (n=97) or familial adenomatous polyposis (n=7) between June 1986 and December 1994.
Interventions
Patients with symptomatic pouchitis were treated with either oral metronidazole or ciprofloxacin.
Outcomes
Diagnosis of pouchitis was determined by clinical symptoms and confirmed with endoscopy. Response to oral antibiotics was determined by resolution of symptoms.
Results
Fifty-two patients (50%) experienced at least 1 episode of pouchitis. The first episode of pouchitis occurred within the first 12 months after restoration of intestinal continuity in 56% of the cases. In 2 patients it occurred after 30 months. Response to antibiotic treatment was 96%. Two thirds of patients had multiple episodes. Chronic pouchitis occurred in 6 patients, necessitating pouch removal in 2.
Conclusions
The incidence of pouchitis after ileal J-pouch anal anastomosis is approximately 50% with two thirds of these patients having multiple episodes. Chronic pouchitis occurs in a minority of patients. In chronic pouchitis, the risk of pouch loss is substantial.
(Arch Surg. 1996;131:497-502)
