POUCHITIS AFTER ILEAL POUCH-ANAL ANASTOMOSIS - A POUCHITIS DISEASE-ACTIVITY INDEX

Objective: To develop a ''Pouchitis Disease Activity Index'' (PDAI) an d to compare it with other diagnostic scoring systems for pouchitis. D esign: We compared patients who had an optimal outcome with those who had a poor result attributable to recurrent pouchitis after ileal pouc h-anal anastomosis (IPAA) for ulcerative colitis at the Mayo Clinic. M aterial and Methods: We evaluated the applicability of a PDAI that qua ntitated clinical findings and the endoscopic and histologic features of acute inflammation in four groups of patients: (1) 10 who underwent IPAA for ulcerative colitis and had symptoms compatible with a clinic al diagnosis of pouchitis, (2) 5 who underwent IPAA for ulcerative col itis and did not have pouchitis, (3) 5 who underwent IPAA for familial adenomatous polyposis and had no symptoms of pouchitis, and (4) 5 who had a Brooke ileostomy for ulcerative colitis (control group). Result s: The PDAI was significantly greater in patients with the clinical fe atures of pouchitis than it was for patients in the other three groups . All 10 patients with pouchitis fulfilled the PDAI criteria for a dia gnosis of pouchitis; in contrast, only 1 of these 10 patients met the diagnostic criteria for pouchitis by application of previously establi shed scoring systems. No asymptomatic patient qualified for a diagnosi s of pouchitis by the PDAI criteria. Conclusion: The PDAI provides sim ple, objective, and quantitative criteria for pouch inflammation after IPAA and is more sensitive than prior scoring systems.