THE IMPLICATIONS OF ACUTE POUCHITIS ON THE LONG-TERM FUNCTIONAL RESULTS AFTER RESTORATIVE PROCTOCOLECTOMY

A prospective study was conducted to determine the implications of acu te pouchitis on the long-term functional results of restorative procto colectomy with J-pouch ileoanal anastomosis (IPAA). Between July 1988 and June 1996, 137 consecutive patients underwent IPAA for treatment o f ulcerative colitis. 127 patients (93%) have been available for follo wup. All patients completed diaries detailing bowel habits over a 7-da y period at 3, 6, 9, 12, 18, 24 months, and yearly after reestablishme nt of intestinal continuity. Diaries were completed only during time p eriods in which patients were not suffering from acute symptomatic pou chitis. Patients with chronic pouchitis (n = 7) were excluded from thi s study leaving 120 patients for analysis. Fifty patients suffered at least one episode of pouchitis (Pouchitis Group). Seventy patients nev er had pouchitis (No Pouchitis Group). Patients with a history of pouc hitis having significantly more bowel movements per day were more like ly to ever have minor incontinence (75% vs. 45%, p < 0.005) or major i ncontinence (37% vs. 17%, p < 0.02). The stools of Pouchitis Group wer e less likely to be formed (24% vs. 31%, p < 0.001). Pouchitis Group p atients also were more Likely to wear a protective pad during the day (21% vs. 7% p < 0.04) or during the night (40% vs. 13%, p < 0.001). Ev en in the absence of clinically active pouchitis, patients who have su ffered at least one episode of pouchitis have a poorer long-term funct ional result after IPAA. The results of this study suggest that ileal pouchitis may represent a chronic condition that displays episodic sym ptomatic exacerbations.