U. Keranen et al., FUNCTIONAL RESULTS AFTER RESTORATIVE PROCTOCOLECTOMY COMPLICATED BY POUCHITIS, Diseases of the colon & rectum, 40(7), 1997, pp. 764-769
This study aimed to examine the incidence and cumulative risk of pouch
itis after restorative proctocolectomy for ulcerative colitis and to e
valuate the clinical and functional results in patients with pouchitis
. METHODS: A total of 291 patients had proctocolectomy with ileal pouc
h-anal anastomosis for ulcerative colitis between January 1985 and Jan
uary 1996. During follow-up, 65 patients had one or more episodes of p
ouchitis based on clinical, histologic, and endoscopic criteria. Funct
ional results and patient satisfaction in these patients were compared
with those of 65 matched control patients who had experienced no epis
odes of pouchitis. RESULTS: Pouchitis developed in 65 patients (22 per
cent), giving rise to a cumulative frequency of 28 percent at 11 years
after the operation. Only 13 patients (4.5 percent) had chronic pouch
itis that required long-lasting treatment. A permanent ileostomy had t
o be constructed in one patient (0.3 percent) because of pouchitis. Du
ring the last year (1995), 60 percent of patients with pouchitis had m
edication, most often metronidazole and/or corticosteroids. Defecation
frequency per 24 hours was 6.7 for all patients with pouchitis, 8.2 f
or those with chronic pouchitis (P < 0.05), and 6.3 for patients witho
ut pouchitis. Nighttime defecation occurred in 44 (80 percent) patient
s with pouchitis, compared with 37 (67 percent) of those without pouch
itis (P > 0.05). Frequencies of soiling or flatus incontinence did not
differ between the two groups. During the last year, 43 (80 percent)
of tile pouchitis patients, who answered the questionnaire, were worki
ng all the pear or were on sick-leave less than one month. CONCLUSIONS
: Episodic pouchitis is easily treated and causes minimum functional c
onsequences, whereas chronic pouchitis increases defecation frequency
and needs prolonged medication. Pouchitis seems not to be a major thre
at to preventing the use of restorative proctocolectomy in ulcerative
colitis, but still the small group of chronic pouchitis patients remai
ns a problem.