Pouchitis in young patients after the ileal pouch-anal anastomosis

The purpose of this study was to determine the incidence of pouchitis after the ileal pouch-anal anastomosis in young patients, and to identify possible predisposing factors. The study design included long-term follow-up of young patients after closure of their temporary diverting ileostomy, through regular visits, a detailed questionnaire, or phone call. The Kaplan-Meier method was used to summarize survival free of pouchitis in several subgroups. A logistic regression analysis of just the patients with pouchitis was used to determine whether any clinical variables could discriminate between those with acute and those with chronic pouchitis. We are closely following 97 patients with an ileal pouch-anal anastomosis - 83 patients for chronic ulcerative colitis and 14 patients for familial polyposis. They have been followed for a median of 7.5 years (range 1-14.5 years). Forty-six patients (47%) developed pouchitis - 44 (53%) patients after ulcerative colitis and 2 (14%) patients after polyposis. Most (92%) had loose and/or frequent stools, many had incontinence (62%) and bloody stools (62%), and less (37%) had cramping. Endoscopy was done in 82% of the patients; erythema and/or friability was seen in all patients, often with ulcers or erosions (35%); no polyposis patients had ulcers. We could not identify any predisposing factor. Metronidazole was the treatment of choice, but some patients required long-term treatment with sulfasalazine and/or steroid enemas. Pouchitis is a common long-term complication of the ileal pouch-anal anastomosis after ulcerative colitis. No predisposing factor has yet been identified in these young patients.