Re: surgery on j-pouch, risk of losing pouch - research needed by

[Guest guest]

Hi Marie;

This paper indicates that there is an increased risk of chronic

pouchitis with PSC, but I don't know whether this translates to a

higher risk of surgery on the pouch, or risk of losing the pouch over

the long term:

Colorectal Dis. 2008 Oct;10(8):805-13.

Predictors for acute and chronic pouchitis following restorative

proctocolectomy for ulcerative colitis.

Abdelrazeq AS, Kandiyil N, Botterill ID, Lund JN, Reynolds JR,

Holdsworth PJ, Leveson SH

Department of General Surgery, York Hospital, York, UK.

aymonrazeq@...

OBJECTIVE: This study was undertaken to evaluate the cumulative

incidence, onset and risk predicting factors for acute and chronic

pouchitis. METHOD: A consecutive series of patients (n = 210), who

underwent restorative proctocolectomy (RPC) and had a minimum follow-

up of 12 months was reviewed. The cumulative incidence and onset of

pouchitis was determined. Univariate analysis, followed by logistic

regression analysis was used to evaluate the association of various

demographic, clinical and histopathologic variables with the

subsequent development of acute and chronic pouchitis. RESULTS: A

total of 198 patients were included. The mean follow-up was 64 months

(range, 12-180). Sixty-four patients (32%) developed pouchitis, 35

acute and 29 chronic. The first episode of pouchitis occurred within

the first year in 70% of cases. The presence of backwash ileitis (OR,

2.6; P = 0.015), primary sclerosing cholangitis (PSC; OR, 2; P =

0.018) and the duration of follow-up (OR, 1.1; P = 0.043) were

associated with a higher incidence of pouchitis. The duration of

follow-up was the only variable associated with acute pouchitis (P =

0.007). The presence of backwash ileitis and PSC were independent

risk factors for chronic pouchitis (OR, 5.9; P < 0.001; OR, 2.8; P =

0.001 respectively). CONCLUSION: Pouchitis is a heterogeneous disease

which tends to occur early after restoration of gastrointestinal

continuity. Patients with backwash ileitis and/or PSC are at

considerable risk of developing chronic pouchitis. The strong

association between backwash ileitis, PSC and chronic pouchitis

suggests a common link in their pathogenesis. PMID: 18005192.

Best regards,

Dave

(father of (23); PSC 07/03; 08/03)

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> I tried to find an article on this but had no luck. Perhaps

can help.

>

> Marie

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