PROSPECTIVE-STUDY OF THE INCIDENCE, TIMING, AND TREATMENT OF POUCHITIS IN 104 CONSECUTIVE PATIENTS AFTER RESTORATIVE PROCTOCOLECTOMY

Objective: To determine the incidence timing and effectiveness of trea tment of symptomatic pouchitis following restorative proctocolectomy w ith ileal J-pouch anal anastomosis. Design: A cohort analytical study. Setting: University hospitals, a tertiary referral center; all subjec ts 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 anasto mosis for either ulcerative colitis (n = 97) or familial adenomatous p olyposis (n = 7) between June 1986 and December 1994. Interventions: P atients with symptomatic pouchitis were treated with either oral metro nidazole or ciprofloxacin. Outcomes: Diagnosis of pouchitis was determ ined by clinical symptoms and confirmed with endoscopy. Response to or al antibiotics was determined by resolution of symptoms. Results: Fift y-two patients (50%) experienced at least 1 episode of pouchitis. The first episode of pouchitis occurred within the first 12 months after r estoration 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 occu rred in 6 patients, necessitating pouch removal in 2. Conclusions: The incidence, of pouchitis after ileal J-pouch anal anastomosis is appro ximately 50% with two thirds of these patients having multiple episode s. Chronic pouchitis occurs in a minority of patients. In chronic pouc hitis, the risk of pouch loss is substantial.