Original Contribution
The American Journal of Gastroenterology (2005) 100, 93–101; doi:10.1111/j.1572-0241.2005.40778.x
Comprehensive Evaluation of Inflammatory and Noninflammatory Sequelae of Ileal Pouch-Anal Anastomoses
Bo Shen MD, Victor W Fazio MB, MS, Feza H Remzi MD, Conor P Delaney MD, PhD, Ana E Bennett MD, Jean-Paul Achkar MD, Aaron Brzezinski MD, Farah Khandwala MS, Wendy Liu MD, PhD, Marlene L Bambrick BSN, RN, Jane Bast RN and Bret Lashner MD, MPH
Center for Inflammatory Bowel Disease, Departments of Gastroenterology/Hepatology, Colorectal Surgery, and Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio
Correspondence: Bo Shen, MD, Department of Gastroenterology/Hepatology—Desk A30, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.
Received 20 July 2004; Accepted 17 August 2004.
Abstract
BACKGROUND AND AIMS:
Ileal pouch-anal anastomosis (IPAA) improves quality of life (QOL) for ulcerative colitis patients who require surgery. Crohn's disease (CD) of the pouch, pouchitis, cuffitis, and irritable pouch syndrome (IPS) have an adverse impact on physical and psychological well-being, which can compromise the gain in QOL after the surgery. Their clinical, endoscopic, and histologic features have not been fully characterized. The aim of this study was to compare demographic, clinical, endoscopic, and histologic features between CD of the pouch, pouchitis, cuffitis, IPS, and normal pouches.
METHODS:
We enrolled 124 patients: normal pouches (N = 26), CD of the pouch (N = 23), pouchitis (N = 22), cuffitis (N = 21), and IPS (N = 32). Symptomatology, endoscopy, histology, and the Cleveland Global QOL and the Irritable Bowel Syndrome-QOL scores were compared among the groups.
RESULTS:
Univariate analysis of demographic and clinical data showed a possible association between NSAID use and pouchitis, extraintestinal manifestation and cuffitis, and antidepressant use and IPS. There were no differences in the Pouchitis Disease Activity Index symptom scores between the disease groups, with an exception of bleeding, which occurred almost exclusively in cuffitis. Endoscopy was useful in discriminating between CD of the pouch, pouchitis, cuffitis, and normal pouches or IPS. Patients with diseased IPAA had worse QOL scores.
CONCLUSIONS:
Symptoms largely overlapped among the disease groups of IPAA. Endoscopy is valuable for diagnosis. Inflammatory or noninflammatory sequelae of IPAA adversely affected patients' QOL.
