The Long-Term Clinical Course of Pouchitis After Total Proctocolectomy and IPAA for Ulcerative Colitis
The Long-Term Clinical Course of Pouchitis After Total Proctocolectomy and IPAA for Ulcerative Colitis
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DOI：
10.1097/dcr.0b013e3182417358
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发表时间：
2012-03-01
影响因子：
3.9
通讯作者：
Sasaki, Iwao
中科院分区：
文献类型：
--
作者：
Suzuki, Hideyuki;Ogawa, Hitoshi;Sasaki, Iwao
背景技术背景：结肠袋炎是溃疡性结肠炎行全结肠直肠切除术和IPAA后最常见的长期并发症。目的：我们研究了特发性结肠袋炎患者的发病率、临床表现和长期预后。设计：本研究是对病历的回顾性分析。患者：本研究包括284例接受全结肠直肠切除术和IPAA的溃疡性结肠炎患者。主要结局指标：我们评估了结肠袋炎的累积风险和长期结果，包括疾病的持续时间，复发的模式，以及对抗生素治疗的反应性。1年时累积风险为10.7%，2年时为17.2%，5年时为24.0%，10年时为38.2%。在第一次结肠袋炎发作时，45例患者患有急性结肠袋炎，19例患者患有慢性结肠袋炎，所有患者均接受口服环丙沙星和/或甲硝唑的抗生素治疗。初步治疗有效率为96.6%。45例患者在首次发作时患有过敏反应性结肠袋炎，17例患者患有过敏依赖性结肠袋炎，2例患者患有过敏难治性结肠袋炎。45例初始急性结肠袋炎患者中有20例（44.4%）经历了2次或2次以上复发，19例初始慢性结肠袋炎患者中有16例（84.2%）经历了2次或2次以上复发。考虑到复发后，过敏反应性结肠袋炎患者数量从45例减少到40例，过敏依赖性结肠袋炎患者数量从17例增加到20例，过敏难治性结肠袋炎患者数量从2例增加到4例。在4例难治性结肠袋炎患者中，有3例艰难梭菌相关性结肠袋炎。局限性：这项研究是回顾性的。结论：慢性结肠袋炎的患者在首次发病往往有较高的复发率。在一些患者中，对抗生素治疗的反应性在随访期间发生变化。当结肠袋炎患者对标准抗生素治疗无反应时，则应考虑艰难梭菌感染的发生。
BACKGROUND: Pouchitis is the most common long-term complication after restorative total proctocolectomy and IPAA for ulcerative colitis.OBJECTIVE: We examined the incidence, clinical aspects, and long-term outcome of patients with idiopathic pouchitis.DESIGN: This study was a retrospective review of medical records.PATIENTS: Included in the study were 284 patients with ulcerative colitis who underwent a total proctocolectomy and IPAA.MAIN OUTCOME MEASURES: We evaluated the cumulative risk and long-term outcome of pouchitis including the duration of disease, pattern of relapse, and responsiveness to antibiotic therapy.RESULTS: Sixty-four patients developed idiopathic pouchitis. The cumulative risk was 10.7% at 1 year, 17.2% at 2 years, 24.0% at 5 years, and 38.2% at 10 years. At their first pouchitis episode, 45 patients had acute pouchitis, 19 patients had chronic pouchitis, and all patients received antibiotic therapy with oral ciprofloxacin and/or metronidazole. The efficacy of the therapy was 96.6% initially. Forty-five patients had antibiotic-responsive pouchitis, 17 patients had antibiotic-dependent pouchitis, and 2 patients had antibiotic-refractory pouchitis at their first episode. Whereas 20 of 45 patients (44.4%) with initially acute pouchitis experienced 2 or more relapses, 16 of 19 patients (84.2%) with initially chronic pouchitis had 2 or more relapses. After taking into account the relapses, the number of patients with antibiotic-responsive pouchitis decreased from 45 to 40, the number with antibiotic-dependent pouchitis increased from 17 to 20, and the number with antibiotic-refractory pouchitis increased from 2 to 4. Among the 4 patients with antibiotic-refractory pouchitis, 3 patients had Clostridium difficile-associated pouchitis.LIMITATIONS: This study was retrospective.CONCLUSION: The patients with chronic pouchitis at the first episode tend to have a higher incidence of relapse. In some patients, the responsiveness to antibiotic therapy changes during follow-up. When patients with pouchitis do not respond to standard antibiotic therapy, then the occurrence of C difficile infection should be considered.