POUCHITIS - RECURRENCE OF THE INFLAMMATORY BOWEL-DISEASE

The incidence and characteristics of reservoir inflammation after rest orative proctocolectomy for ulcerative colitis were studied in a serie s of 179 patients. The median follow up time was 27 months (range 6-80 ). Pouchitis occurred in 36 patients (20%) and nine of these (5%) deve loped a chronic, persisting pouchitis. There were no pouch failures as a result of pouchitis and no significant adverse effect on longterm f unctional outcome. The overall cumulative risk to develop pouchitis fo ur years after surgery was 23%. The risk of pouchitis is unpredictable on clinical grounds except that there were significantly less patient s with left sided colitis in the group who subsequently developed pouc hitis. Morphological and histochemical studies showed a greater degree of colonic metaplasia in the pouch mucosa in patients with pouchitis and patients with a chronic pouchitis had the highest degree of change s. The results support the view that pouchitis is a novel manifestatio n of inflammatory bowel disease in heal mucosa that has changed slowly to a colon like mucosa.