Nonspecific, Acute Pouchitis in Patients with Familial Adenomatous Polyposis: Less Common than We Think.

Abstract

BACKGROUND\nNonspecific, acute, pouchitis is common in patients with ulcerative colitis who undergo ileal pouch-anal anastomosis, but there is disagreement about the rate at which this occurs in patients with familial adenomatous polyposis.\n\n\nOBJECTIVE\nTo define the rate at which nonspecific, acute, pouchitis occurs in patients with familial adenomatous polyposis.\n\n\nSETTING\nHereditary colorectal cancer center in a large academic medical center.\n\n\nDESIGN\nRetrospective cohort study using prospectively gathered data.\n\n\nPATIENTS\nPatients with familial adenomatous polyposis who have had ileal pouch-anal anastomosis.\n\n\nINTERVENTIONS\nSymptoms, pouchoscopy and pouch radiography, pouch biopsy.\n\n\nMAIN OUTCOME MEASURES\npresence of nonspecific acute pouchitis; alternative diagnoses of pouch dysfunction.\n\n\nRESULTS\nThere were 250 patients with familial adenomatous polyposis who had undergone an ileal pouch anal anastomosis; 38 (15.2%) had been labelled as having pouchitis, 23 males and 15 females. Median age was 55 years (range 18 to 90 years). No patient had nonspecific, acute, pouchitis as defined by our criteria. In 9 cases the diagnosis was derived from benign ulcers common in ileal pouches. Stool frequency was the most common symptom associated with the pouchitis label, but actual causes for the frequency included poor pouch emptying, poor eating habits, poor bowel habits and afferent limb syndrome. Median stool frequency was 9, ranging from 4 to 15 per day. Every patient had at least one pouch endoscopy: the median number was 19 per patient (range 1 to 21). Nine patients had pouch biopsies to rule out inflammation: all showed chronic active enteritis, a normal finding in ileal pouches.\n\n\nLIMITATIONS\nRetrospective nature of the study.\n\n\nCONCLUSIONS\nWe could not confirm any case of nonspecific, acute, pouchitis in patients with FAP. Those caring for FAP patients with a pouch should seek causes for pouch-related symptoms other than pouchitis. See Video Abstract at http://links.lww.com/DCR/B666.