FUNCTIONAL RESULTS AFTER RESTORATIVE PROCTOCOLECTOMY COMPLICATED BY POUCHITIS

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.