Association between gastro-intestinal symptoms and menstruation in patients with ileal pouches.

Background And Aims: Gastro-intestinal (GI) symptoms are often experienced by healthy women during menstruation. An increased frequency of GI symptoms during menses has also been reported in women with irritable bowel syndrome or inflammatory bowel disease (IBD); however, IBD patients with restorative proctocolectomy and ileal pouch-anal anastomoses (IPAA) have not been studied. We aimed to examine the association between GI symptoms before and during menses in patients with IPAA, and to assess factors for exacerbation of GI symptoms in those patients.

Preoperative Clostridium difficile infection is not associated with an increased risk for the infection in ileal pouch patients.

Background: Clostridium difficile infection (CDI) might contribute to a refractory course of pouchitis. However, the association between preoperative CDI and postoperative CDI in ileal pouch patients has not been investigated.

Aim: Our study aimed to evaluate whether preoperative CDI had an impact on the occurrence of postoperative CDI in pouch patients.

Chronic pouchitis is associated with pouch polyp formation in patients with underlying ulcerative colitis.

Background: Polypoid lesions can develop in ileal pouches. The risk factors associated with the development of pouch polyps have not been studied.

Aim: To characterize clinical features, risk factors, and disease course of pouch polyp in a cohort of patients with underlying inflammatory bowel disease (IBD) from a subspecialty clinic.

Clinical value of surveillance pouchoscopy in asymptomatic ileal pouch patients with underlying inflammatory bowel disease.

Background: There is no consensus on the need for and the interval of surveillance pouchoscopy in asymptomatic ileal pouch patients with underlying ulcerative colitis (UC). The purpose of this study was to evaluate the likelihood of finding dysplasia or incidental ileal pouch disorders in asymptomatic patients undergoing surveillance pouchoscopy.

Methods: This study included all eligible consecutive asymptomatic UC patients undergoing surveillance pouchoscopy to our subspecialty Pouchitis Clinic from 2002 to 2011.

Risk factors and outcome of PCR-detected Clostridium difficile infection in ileal pouch patients.

Background: The clinical implication of Clostridium difficile infection (CDI) in patients with ileal pouch-anal anastomosis (IPAA) for underlying inflammatory bowel disease (IBD) has not been well studied. This study was designed to investigate the cumulative incidence, risk factors, and outcome of CDI in patients with ileal pouches.

Methods: Consecutive IPAA patients (n = 196) from the subspecialty Pouchitis Clinic with an increase of at least three stools per day more from the postoperative baseline for more than 4 weeks were enrolled from October 2010 to December 2011.

Utility of fecal and serum anti-Saccharomyces cerevisiae antibodies in the diagnosis of Crohn's disease-like condition of the pouch.

Background: Fecal antibodies against bacterial products may directly reflect the interaction between luminal bacteria and mucosal immunity, and assays for these antibodies may be clinically useful in the diagnosis and differential diagnosis of Crohn's disease-like (CDL) condition of the pouch.

Aims: This study aims to evaluate stool and serum anti-Saccharomyces cerevisiae antibodies (ASCA) in normal and diseased pouches, to assess the correlation between ASCA levels and endoscopic disease activity, and to ascertain the diagnostic utility of ASCA for CDL of the pouch.

Methods: One hundred eighty-nine patients with ileal pouches were prospectively enrolled and corresponding serum and pouch aspirate samples were collected.

Adalimumab therapy in Crohn's disease of the ileal pouch.

Background: Crohn's disease (CD) of the pouch can develop in patients with ileal pouch-anal anastomosis, resulting in significant morbidities, even pouch failure. The aim of this study was to evaluate short- and long-term outcome of adalimumab (ADA) in treating these patients.

Methods: A total of 48 patients who received ADA for CD of the pouch from June 2006 to June 2011 were identified from our prospectively maintained Pouchitis Registry Complete clinical response was defined as the resolution of symptoms as well as the modified Pouchitis Disease Activity Index (mPDAI) score being less than 5.

Efficacy and safety of endoscopic treatment of ileal pouch strictures.

Background: Endoscopic management of ileal pouch strictures has not been systemically studied. The aim was to evaluate endoscopic balloon therapy of pouch strictures in inflammatory bowel disease (IBD) patients with ileal pouches and to identify risk factors for pouch failure for those patients.

Methods: Consecutive IBD patients with pouches from the Pouchitis Clinic who underwent nonfluoroscopy-guided outpatient endoscopic therapy were studied.

The efficacy and tolerability of AST-120 (spherical carbon adsorbent) in active pouchitis.

Objectives: Although a majority of patients with pouchitis respond favorably to antibiotic therapy, many relapse frequently, and nonabsorbable and non-antibiotic-based agents are desirable for reducing bacterial resistance and the systemic adverse effects associated with long-term antibiotic exposure. AST-120 (a spherical carbon adsorbent) comprises highly adsorptive, porous carbon microspheres with the ability to adsorb small-molecular-weight toxins, inflammatory mediators,and harmful bile acids. The aim of this pilot trial was to evaluate the efficacy and tolerability of AST-120 in the treatment of active pouchitis.

Association between immune-associated disorders and adverse outcomes of ileal pouch-anal anastomosis.

Objectives: Autoimmune disorders (ADs) frequently coexist with inflammatory bowel disease. The aim of the study was to determine whether coexisting AD in patients with ileal pouches increases the risk for chronic antibiotic-refractory pouchitis (CARP) and other inflammatory conditions of the pouch.

Methods: A total of 622 patients seen in our Pouchitis Clinic were enrolled.

Risk factors for low bone mass in patients with ulcerative colitis following ileal pouch-anal anastomosis.

Objectives: Bone mineral density (BMD) can be adversely affected by the chronic nature of inflammatory bowel disease. Ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with ulcerative colitis (UC) who require proctocolectomy. There are few data on BMD in UC patients with IPAA.

Enterochromaffin cell hyperplasia in irritable pouch syndrome.

Background: Irritable pouch syndrome (IPS) is a functional disease in patients with ileal pouch-anal anastomosis following colectomy for ulcerative colitis (UC). The pathophysiology of IPS is characterized by the presence of visceral hypersensitivity, similar to that seen in irritable bowel syndrome. However, the exact etiology and pathogenesis of IPS are not known.

Rifaximin for maintenance therapy in antibiotic-dependent pouchitis.

Background: Pouchitis is the most common long-term complication of in patients with restorative proctocolectomy and ileal pouch-anal anastomosis. Patients often develop antibiotic-dependent form of pouchitis requiring long-term antibiotic therapy for remission maintenance. Rifaximin, an oral, non-systemic, broad-spectrum antibiotic with a favorable safety profile, may be a promising candidate agent for maintenance therapy.

Clostridium difficile infection in patients with ileal pouch-anal anastomosis.

Background & Aims: There has been an increase in the incidence and severity of Clostridium difficile-associated diarrhea in the U.S. The importance of C difficile infection in patients with ileal pouch-anal anastomosis (IPAA) is unknown.

Risk factors for pouch failure in patients with different phenotypes of Crohn's disease of the pouch.

Background: Crohn's disease (CD) of the pouch is one of the leading causes of pouch failure in patients with restorative proctocolectomy. Risk factors for pouch failure in these patients are yet to be identified. The aim of the study was to assess risk factors associated with pouch failure in patients with CD of the pouch.

Evaluation of tissue eosinophilia in the pouch and afferent limb in patients with restorative proctocolectomy.

Background: Although tissue eosinophilia in mucosal biopsy specimens from the ileal pouch in patients treated with restorative proctocolectomy is frequently seen, its clinical significance has not been investigated. The aim of this study was to assess whether tissue eosinophilia was associated with disease status of ileal pouches.

Methods: Hematoxylin and eosin slides of pouch and afferent limb biopsy specimens from 106 patients randomly selected from the Pouchitis Database were evaluated by 2 gastrointestinal pathologists.