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Pouchitis


Presentation

  • Based on its clinical presentation and serology, it can be classified either as arthritis accompanying ileal pouchitis, or as an undifferentiated spondyloarthropathy.[ncbi.nlm.nih.gov]
Fever
  • A 35-year old female presented with fever and abdominal pain five weeks after ileostomy closure following proctocolectomy. Computed tomography showed collection of feces in the pouch and proximal ileum.[ncbi.nlm.nih.gov]
Enthesopathy
  • It was accompanied by enthesopathy (2 patients) and by sacroiliitis (2 patients). All had active pouchitis. The abnormal laboratory test results were nonspecific, indicating chronic inflammation.[ncbi.nlm.nih.gov]
Musculoskeletal Pain
  • A high index of suspicion is required when assessing new or worsening musculoskeletal pain in patients receiving infliximab and involvement of a rheumatologist at an early stage is essential in order to appropriately diagnose and manage this condition[ncbi.nlm.nih.gov]
Oliguria
  • A 61-year-old woman who had undergone an ileostomy closure 10 days previously presented to a tertiary medical center with abdominal pain, vomiting, diarrhea, dehydration, and oliguria.[ncbi.nlm.nih.gov]

Workup

  • Provides all the necessary tools to make a comprehensive diagnostic workup including data from ancillary techniques and molecular findings whenever appropriate.[books.google.com]
Clostridium Perfringens
  • Sequencing results showed that similar microbiota, such as Clostridium perfringens , were shared in both UC and pouchitis. CONCLUSION: Less diverse fecal microbiota was present in patients with UC and pouchitis.[ncbi.nlm.nih.gov]
  • During pouchitis episodes, we found a significant decrease of anaerobes ( P 0.01), a significant increase of aerobic bacteria ( P 0.01), and significantly more numbers of pathogens, such as Clostridium perfringens (in 95 percent of the samples; P 0.01[doi.org]
  • Additionally sufferers have been shown to have decreased levels of the beneficial bacteria lactobacilli and bifidobacteria in their colons, more of the less helpful bacteria Clostridium perfringens, as well as species such as fungi that were not found[probiotics-help.com]
  • Two unrelated taxa that were dominant during this study, Cetobacterium somerae and Clostridium perfringens ( 44 , 45 ), each might contain genes that contribute to evading an immune response and/or eliciting an abnormal immune response.[mbio.asm.org]
Clostridium Difficile Toxin in Stool
  • Assays for Clostridium difficile toxins in stool specimens were positive. He was treated with a 4-week course of ciprofloxacin 500 mg BID and tinidazole 500 mg TID. His symptoms resolved within several days from the initiation of therapy.[ncbi.nlm.nih.gov]
HLA-B27
  • Abstract The case of an HLA B27( ) patient who developed inflammatory arthritis accompanying ileal pouchitis, following total proctocolectomy for familial adenomatous polyposis is presented for the first time in the literature.[ncbi.nlm.nih.gov]

Treatment

  • Ten to 15% of patients develop chronic pouchitis, either treatment responsive or treatment refractory.[ncbi.nlm.nih.gov]

Prognosis

  • The long-term prognosis is good, and the risk of malignant transformation appears to be very low.[journals.lww.com]
  • The etiology, natural history, malignant potential, and treatment and prognosis of pouch polyp in these patients have not been well defined.[academic.oup.com]
  • PROGNOSIS AND TREATMENT CHARACTERIZATION PROGNOSTIC FACTORS Histologic Predictors of Pouchitis in Patients with Chronic Ulcerative Colitis. Yantiss RK, Sapp HL, Farraye FA, El-Zammar O, O'Brien MJ, Fruin AB, Stucchi AF, Brien TP, Becker JM, Odze RD.[thedoctorsdoctor.com]

Etiology

  • Based on the etiology we can sub-divide pouchitis into 2 groups: idiopathic and secondary.[ncbi.nlm.nih.gov]
  • In addition, the etiological and pathogenetic factors may play different roles at different stages of pouchitis in a given patient.[agaperspectives.gastro.org]
  • Although the etiology and pathogenesis of pouchitis are not entirely clear, bulk of evidence points towards an abnormal mucosal immune response (innate and adaptive) to altered microflora in the pouch leading to acute and/or chronic inflammation.[gastrotraining.com]

Pathophysiology

  • […] an artificial rectum surgically created out of ileal gut tissue in patients who have undergone a colectomy), which is created in the management of patients with ulcerative colitis, indeterminate colitis, FAP, or, rarely, other colitides.A variety of pathophysiological[en.wikipedia.org]
  • This article gives a survey of the actual state of the pathophysiology, pathogenesis and therapy of this disease. In addition, the surgical aspects of the disease are described. 2002 S.[karger.com]
  • A variety of pathophysiological mechanisms have been proposed for pouchitis, but the precise pathogenesis (biological cause) remains unknown.[humpath.com]
  • The Superoxide free radical: its biochemistry and pathophysiology. Surgery 1983;94:412–4. PubMed Google Scholar 8. McCord JM. Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 1985;312:159–63. PubMed CrossRef Google Scholar 9.[link.springer.com]

Prevention

  • There are two strategies to prevent pouchitis, the primary (i.e., the prevention of the initial episode) and secondary (i.e., the prevention of recurrent episodes) prophylaxis. There are scant data in the literature on nutritional aspects.[ncbi.nlm.nih.gov]

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