Pouchitis After IPAA Surgery

Pouchitis is a condition that occurs in some people who have had a surgery known as ileal pouch-anal anastomosis (IPAA), which is commonly called a j-pouch. When the j-pouch becomes inflamed and causes symptoms of diarrhea (sometimes bloody), an urgent need to pass stool, incontinence, and pain or discomfort while passing stool, it is called pouchitis. Not everyone who has a j-pouch gets pouchitis, but some people get it periodically, and a few get it frequently enough that it might be labeled "chronic."

J-Pouch Surgery

J-pouch surgery is done to treat ulcerative colitis, and some other digestive conditions, such as familial adenomatous polyposis (FAP). This surgery is often done in several steps (typically 2 steps, but sometimes 3), although occasionally it is done with one. The first part of the surgery is the surgical removal of the large intestine, called a colectomy. All or part of the rectum may also be removed at the same time.

The second part of the surgery, which may be done at the same time as the colectomy, is the creation of the j-pouch and an ileostomy. To create the pouch, the terminal ileum is sewn into the shape of a "J" (although other shapes are sometimes also done). If the surgery is being done as more than one step, the last part of the process is to reverse the ileostomy and have the j-pouch function. This allows a person to go to the bathroom more "normally," and not need an ostomy bag, such as with an ileostomy.

Pouchitis

Some people with j-pouches experience a complication that is called pouchitis. Pouchitis is more common in people who have j-pouch surgery to treat ulcerative colitis than for FAP or for other reasons. Pouchitis is fairly common, and the exact cause is not known, though there are some working theories. The symptoms of pouchitis can include:

• Fever
• Bloody stools
• Pain with defecation
• Fecal soiling or urgent need to empty the pouch

The Occurrence of Pouchitis With J-Pouch Surgery

There are varying reports of what percentage of people with j-pouches for ulcerative colitis experience pouchitis. Based on the results of different studies, pouchitis could happen anywhere from 30% to 50% of patients. At the onset of symptoms, a physician will help in diagnosing pouchitis, because the symptoms could mimic that of other conditions, so those would need to be ruled out. Often this is done with a pouchoscopy, which is a type of endoscopy that is used to look inside a j-pouch.

Different Types of Pouchitis

Pouchitis is generally divided into acute pouchitis and chronic pouchitis. Acute pouchitis is when symptoms have been occurring for less than 4 weeks. When symptoms go on for more than 4 weeks, the condition is called chronic pouchitis.

It's increasingly being understood that pouchitis may be more than one condition, it may be a spectrum. Not every patient responds in the same way to the same treatments and some patients need ongoing treatment to achieve relief from symptoms.

Getting the symptoms under control is important to avoid more complications and to keep the pouch functioning well. People with j-pouches are already at risk for dehydration, and persistent diarrhea from pouchitis could very quickly lead to dehydration. Of course, there's also a quality of life issue: pouchitis will have a profound effect on a patient's life, and getting it into remission is key.

Most of the time, the reason that pouchitis occurs isn't known. But in an estimated 30% of people, it is a condition called secondary pouchitis. In the instance of secondary pouchitis, a reason might be identified, and some of these include:

• Autoimmune causes
• Infections
• Ischemia
• Use of non-steroidal anti-inflammatory drugs (NSAIDs)

How Pouchitis Is Treated

In most cases, pouchitis is treated with antibiotics. In some cases, a course of antibiotics will clear up the pouchitis. In other cases, antibiotics might be needed for a longer-term. Some people may be switched from one antibiotic to another, or receive alternating antibiotic treatment, in order to treat the pouchitis.

If the pouchitis doesn't respond to antibiotics, a physician may decide to prescribe another therapy, such as an anti-inflammatory drug or an immunosuppressive drug.

Pronunciation: pouch-EYE-tis