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- W2079425193 abstract "Restorative proctocolectomy is the procedure of choice for patients who require surgical treatment for ulcerative colitis. The diseased colon and rectum are removed and a pelvic reservoir (pouch) is constructed from healthy ileum and anastomosed to the anal sphincter (1). A permanent ileostomy is thus avoided and anal continence is preserved. The patients' quality of life is good (2). The ileal reservoir may become inflamed. Although chronic inflammatory changes are almost universal and asymptomatic, acute inflammation with mucosal ulceration results in the clinical condition of 'acute pouchifis'. It affects 10-20% of patients (3) and is characterised by intermittent episodes of increased frequency of urgent bowel action, loose, bloodstained stools, malaise and lower abdominal discomfort. Extraintesfinal manifestations, as seen in colitics, may occur at the same time as relapses of pouchitis (4). Focal erythema, ulceration and contact bleeding are seen and histologically there is a marked acute inflammatory infiltrate with villous atrophy, crypt abscesses and superficial ulceration. The condition shares many similarities with ulcerative colitis and, although the aefiology of both conditions remains undetermined, it is likely that they are closely linked. Clinical and experimental studies suggest that pouchifis represents a novel recurrence of chronic ulcerative colitis in pelvic ileal reservoirs (5). Villous atrophy is accompanied by a neutrophil and eosinophil inflammatory response with a less marked ingress of mononuclear inflammatory cells and Paneth cell hyperplasia. The mucosa partially develops a colonic phenotype (6) with a significant increase in sulphomucin-containing goblet cells. Chronic ulcerative colitis and pouchitis are likely to share similar aefiological factors (7). Pouchitis is very rare after restorative proctocolectomy for non-colitic indications such as familial adenomatous polyposis (FAP) and it has been suggested that the occasional well documented case of pouchifis in a patient with FAP (8) may represent coexistence of FAP and ulcerative colitis in the same patient (9). As the condition is frequently responsive to metronidazole, a bacterial cause has been suggested. However, no differences in faecal flora have been demonstrated between patients with and without acute pouchitis. Inefficient evacuation of the pouch at defaecation may result in stasis and an increase in the proportion of anaerobes to aerobes. No correlation exists, however, between numbers of specific bacteria or the efficiency of evacuation of the pouch and the severity of pouchitis (10). Alternative explanations have included mucosal ischaemia, mucosal prolapse and Crohn's disease but it is likely that these are conditions which produce similar features to those seen in acute pouchitis rather than being the cause of the condition. We postulate that both ulcerative colitis and acute pouchitis may be a manifestation of enterocyte fuel deficiency." @default.
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- W2079425193 date "1995-02-01" @default.
- W2079425193 modified "2023-09-27" @default.
- W2079425193 title "Pouchitis, colitis and deficiencies of fuel" @default.
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- W2079425193 doi "https://doi.org/10.1016/s0261-5614(06)80004-x" @default.
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