Irritable pouch syndrome

A new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis

Bo Shen, Jean Paul Achkar, Bret A. Lashner, Adrian H. Ormsby, Aaron Brzezinski, Edy E. Soffer, Feza H. Remzi, Charles L Bevins, Victor W. Fazio

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

OBJECTIVE: Pouchitis often is diagnosed based on symptoms alone. However, increased stool frequency, urgency, and abdominal pain could be due to a condition resembling irritable bowel syndrome. This study was designed to assess the etiology of bowel symptoms using the Pouchitis Disease Activity Index (PDAI). METHODS: Symptoms, endoscopy, and histology were assessed in 61 consecutive symptomatic patients with ulcerative colitis after ileal pouch-anal anastomosis. Pouchitis was defined as a PDAI score of ≥7, cuffitis was defined as endoscopic and histological inflammation of the rectal cuff and no inflammation of the pouch, and irritable pouch syndrome (IPS) was defined as symptoms with a PDAI of <7 and the absence of cuffitis. RESULTS: Thirty-one patients (50.8%) had pouchitis, four (6.5%) had cuffitis, and 26 (42.6%) had IPS. Demographics were similar in the three groups. Increased stool frequency, urgency, and abdominal cramps were the most common symptoms in the three groups. Rectal bleeding was seen only in cuffitis (p < 0.001). No patient in the three groups had fever. Twenty-seven patients (87.1%) with pouchitis responded to a 2-wk course of ciprofloxacin or metronidazole with a reduction in PDAI scores of ≥3. All four patients with cuffitis responded to topical hydrocortisone or mesalamine with a reduction in the PDAI symptom component score of ≥1. Twelve patients with IPS (46.2%) responded to antidiarrheal, anticholinergic, and/or antidepressant therapies with a reduction in the PDAI symptom component score of ≥1, whereas the remaining patients had persistent symptoms despite therapy. CONCLUSIONS: A substantial number of symptomatic patients after ileal pouch-anal anastomosis do not meet the diagnostic criteria for either pouchitis or cuffitis and have been classified as having IPS. There is an overlap of symptoms among patients with pouchitis, cuffitis, and IPS, and endoscopic evaluation can differentiate among these groups. Distinction between these three groups has therapeutic implications.

Original languageEnglish (US)
Pages (from-to)972-977
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume97
Issue number4
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Pouchitis
Colonic Pouches
Antidiarrheals
Inflammation
Mesalamine
Colic
Irritable Bowel Syndrome
Metronidazole
Cholinergic Antagonists
Ciprofloxacin
Ulcerative Colitis
Abdominal Pain
Antidepressive Agents
Endoscopy
Hydrocortisone

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Shen, B., Achkar, J. P., Lashner, B. A., Ormsby, A. H., Brzezinski, A., Soffer, E. E., ... Fazio, V. W. (2002). Irritable pouch syndrome: A new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis. American Journal of Gastroenterology, 97(4), 972-977. https://doi.org/10.1016/S0002-9270(02)03973-4

Irritable pouch syndrome : A new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis. / Shen, Bo; Achkar, Jean Paul; Lashner, Bret A.; Ormsby, Adrian H.; Brzezinski, Aaron; Soffer, Edy E.; Remzi, Feza H.; Bevins, Charles L; Fazio, Victor W.

In: American Journal of Gastroenterology, Vol. 97, No. 4, 2002, p. 972-977.

Research output: Contribution to journalArticle

Shen, Bo ; Achkar, Jean Paul ; Lashner, Bret A. ; Ormsby, Adrian H. ; Brzezinski, Aaron ; Soffer, Edy E. ; Remzi, Feza H. ; Bevins, Charles L ; Fazio, Victor W. / Irritable pouch syndrome : A new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis. In: American Journal of Gastroenterology. 2002 ; Vol. 97, No. 4. pp. 972-977.
@article{038691bbee1345c8a0344565ed8b4a48,
title = "Irritable pouch syndrome: A new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis",
abstract = "OBJECTIVE: Pouchitis often is diagnosed based on symptoms alone. However, increased stool frequency, urgency, and abdominal pain could be due to a condition resembling irritable bowel syndrome. This study was designed to assess the etiology of bowel symptoms using the Pouchitis Disease Activity Index (PDAI). METHODS: Symptoms, endoscopy, and histology were assessed in 61 consecutive symptomatic patients with ulcerative colitis after ileal pouch-anal anastomosis. Pouchitis was defined as a PDAI score of ≥7, cuffitis was defined as endoscopic and histological inflammation of the rectal cuff and no inflammation of the pouch, and irritable pouch syndrome (IPS) was defined as symptoms with a PDAI of <7 and the absence of cuffitis. RESULTS: Thirty-one patients (50.8{\%}) had pouchitis, four (6.5{\%}) had cuffitis, and 26 (42.6{\%}) had IPS. Demographics were similar in the three groups. Increased stool frequency, urgency, and abdominal cramps were the most common symptoms in the three groups. Rectal bleeding was seen only in cuffitis (p < 0.001). No patient in the three groups had fever. Twenty-seven patients (87.1{\%}) with pouchitis responded to a 2-wk course of ciprofloxacin or metronidazole with a reduction in PDAI scores of ≥3. All four patients with cuffitis responded to topical hydrocortisone or mesalamine with a reduction in the PDAI symptom component score of ≥1. Twelve patients with IPS (46.2{\%}) responded to antidiarrheal, anticholinergic, and/or antidepressant therapies with a reduction in the PDAI symptom component score of ≥1, whereas the remaining patients had persistent symptoms despite therapy. CONCLUSIONS: A substantial number of symptomatic patients after ileal pouch-anal anastomosis do not meet the diagnostic criteria for either pouchitis or cuffitis and have been classified as having IPS. There is an overlap of symptoms among patients with pouchitis, cuffitis, and IPS, and endoscopic evaluation can differentiate among these groups. Distinction between these three groups has therapeutic implications.",
author = "Bo Shen and Achkar, {Jean Paul} and Lashner, {Bret A.} and Ormsby, {Adrian H.} and Aaron Brzezinski and Soffer, {Edy E.} and Remzi, {Feza H.} and Bevins, {Charles L} and Fazio, {Victor W.}",
year = "2002",
doi = "10.1016/S0002-9270(02)03973-4",
language = "English (US)",
volume = "97",
pages = "972--977",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "4",

}

TY - JOUR

T1 - Irritable pouch syndrome

T2 - A new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis

AU - Shen, Bo

AU - Achkar, Jean Paul

AU - Lashner, Bret A.

AU - Ormsby, Adrian H.

AU - Brzezinski, Aaron

AU - Soffer, Edy E.

AU - Remzi, Feza H.

AU - Bevins, Charles L

AU - Fazio, Victor W.

PY - 2002

Y1 - 2002

N2 - OBJECTIVE: Pouchitis often is diagnosed based on symptoms alone. However, increased stool frequency, urgency, and abdominal pain could be due to a condition resembling irritable bowel syndrome. This study was designed to assess the etiology of bowel symptoms using the Pouchitis Disease Activity Index (PDAI). METHODS: Symptoms, endoscopy, and histology were assessed in 61 consecutive symptomatic patients with ulcerative colitis after ileal pouch-anal anastomosis. Pouchitis was defined as a PDAI score of ≥7, cuffitis was defined as endoscopic and histological inflammation of the rectal cuff and no inflammation of the pouch, and irritable pouch syndrome (IPS) was defined as symptoms with a PDAI of <7 and the absence of cuffitis. RESULTS: Thirty-one patients (50.8%) had pouchitis, four (6.5%) had cuffitis, and 26 (42.6%) had IPS. Demographics were similar in the three groups. Increased stool frequency, urgency, and abdominal cramps were the most common symptoms in the three groups. Rectal bleeding was seen only in cuffitis (p < 0.001). No patient in the three groups had fever. Twenty-seven patients (87.1%) with pouchitis responded to a 2-wk course of ciprofloxacin or metronidazole with a reduction in PDAI scores of ≥3. All four patients with cuffitis responded to topical hydrocortisone or mesalamine with a reduction in the PDAI symptom component score of ≥1. Twelve patients with IPS (46.2%) responded to antidiarrheal, anticholinergic, and/or antidepressant therapies with a reduction in the PDAI symptom component score of ≥1, whereas the remaining patients had persistent symptoms despite therapy. CONCLUSIONS: A substantial number of symptomatic patients after ileal pouch-anal anastomosis do not meet the diagnostic criteria for either pouchitis or cuffitis and have been classified as having IPS. There is an overlap of symptoms among patients with pouchitis, cuffitis, and IPS, and endoscopic evaluation can differentiate among these groups. Distinction between these three groups has therapeutic implications.

AB - OBJECTIVE: Pouchitis often is diagnosed based on symptoms alone. However, increased stool frequency, urgency, and abdominal pain could be due to a condition resembling irritable bowel syndrome. This study was designed to assess the etiology of bowel symptoms using the Pouchitis Disease Activity Index (PDAI). METHODS: Symptoms, endoscopy, and histology were assessed in 61 consecutive symptomatic patients with ulcerative colitis after ileal pouch-anal anastomosis. Pouchitis was defined as a PDAI score of ≥7, cuffitis was defined as endoscopic and histological inflammation of the rectal cuff and no inflammation of the pouch, and irritable pouch syndrome (IPS) was defined as symptoms with a PDAI of <7 and the absence of cuffitis. RESULTS: Thirty-one patients (50.8%) had pouchitis, four (6.5%) had cuffitis, and 26 (42.6%) had IPS. Demographics were similar in the three groups. Increased stool frequency, urgency, and abdominal cramps were the most common symptoms in the three groups. Rectal bleeding was seen only in cuffitis (p < 0.001). No patient in the three groups had fever. Twenty-seven patients (87.1%) with pouchitis responded to a 2-wk course of ciprofloxacin or metronidazole with a reduction in PDAI scores of ≥3. All four patients with cuffitis responded to topical hydrocortisone or mesalamine with a reduction in the PDAI symptom component score of ≥1. Twelve patients with IPS (46.2%) responded to antidiarrheal, anticholinergic, and/or antidepressant therapies with a reduction in the PDAI symptom component score of ≥1, whereas the remaining patients had persistent symptoms despite therapy. CONCLUSIONS: A substantial number of symptomatic patients after ileal pouch-anal anastomosis do not meet the diagnostic criteria for either pouchitis or cuffitis and have been classified as having IPS. There is an overlap of symptoms among patients with pouchitis, cuffitis, and IPS, and endoscopic evaluation can differentiate among these groups. Distinction between these three groups has therapeutic implications.

UR - http://www.scopus.com/inward/record.url?scp=0036117765&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036117765&partnerID=8YFLogxK

U2 - 10.1016/S0002-9270(02)03973-4

DO - 10.1016/S0002-9270(02)03973-4

M3 - Article

VL - 97

SP - 972

EP - 977

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 4

ER -