Materiały źródłowe

• #1 Pouchitis: Epidemiology, pathogenesis, clinical features, and diagnosis – UpToDate

  https://www.uptodate.com/contents/pouchitis-epidemiology-pathogenesis-clinical-features-and-diagnosis

  Pouchitis: Epidemiology, pathogenesis, clinical features, and diagnosis […] This topic will review the epidemiology, pathogenesis, clinical features, and diagnosis of acute pouchitis. […] Pouchitis is an inflammatory disorder that typically presents with increased stool frequency and urgency and is a common complication of IPAA or a continent ileostomy (eg, Kock pouch).

• #2 Pouchitis: Epidemiology, pathogenesis, clinical features, and diagnosis – UpToDate

  https://www.uptodate.com/contents/pouchitis-epidemiology-pathogenesis-clinical-features-and-diagnosis/print

  Pouchitis is an inflammatory disorder that typically presents with increased stool frequency and urgency and is a common complication of IPAA or a continent ileostomy (eg, Kock pouch). […] This topic will review the epidemiology, pathogenesis, clinical features, and diagnosis of acute pouchitis.

• #3 Incidence, Risk Factors, and Outcomes of Pouchitis and Pouch-Related Complications in Patients With Ulcerative Colitis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32585362/

  Acute pouchitis is the most common non-surgical complication after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). […] The cumulative incidence of pouchitis within 2 years of IPAA was 48% (95% CI, 44%-52%). […] In a geographically diverse population, 48% of patients with UC developed pouchitis within the first 2 years after IPAA. Patients with pouchitis had greater use of healthcare resources, indicating a significant burden of disease.

• #4 Incidence, Risk Factors, and Outcomes of Pouchitis and Pouch-related Complications in Patients with Ulcerative Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8552292/

  Acute pouchitis is the most common non-surgical complication after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). […] In a geographically diverse population, 48% of patients with UC developed pouchitis within the first 2 years after IPAA. Patients with pouchitis had greater use of healthcare resources. […] The cumulative incidence of pouchitis within 2 years of IPAA was 48% (95% CI, 44%52%). […] The cumulative incidence of isolated acute pouchitis was 29% (95% CI, 26%33%). […] Patients who developed pouchitis were more likely to have a history of primary sclerosing cholangitis (adjusted odds ratio [aOR], 3.94; 95% CI, 1.0514.8) and anti-tumor necrosis factor alpha therapy prior to colectomy (aOR 1.63; 95% CI, 1.092.45). […] In a multivariable analysis, patients with a history of PSC prior to IPAA demonstrated a significant increase in odds of developing pouchitis (adjusted Odds Ratio [aOR] 3.94, 95% CI 1.05 14.8).

• #5

  https://journals.lww.com/ctg/fulltext/2024/02000/extraintestinal_manifestations_and_family_history.6.aspx

  Our understanding of the epidemiology of inflammatory conditions of the pouch and effectiveness of treatment is largely based on selected populations. We created a state-level registry to evaluate the incidence of pouchitis and the effectiveness of treatments used in an initial episode of pouchitis. […] Given indications that the incidence of pouchitis may actually be increasing in recent decades, there is a defined need for an improved understanding of the epidemiology and natural history after IPAA for UC. […] The primary outcome of interest was the incidence of pouchitis within the first 12 months after restorative proctocolectomy with IPAA for UC. […] In a multivariable logistic regression, patients with EIM of IBD demonstrated a significant increase in the odds of developing pouchitis within the first 12 months after IPAA after adjusting for family history of IBD. […] In this state-level analysis of outcomes after IPAA for UC, almost one-third of patients developed pouchitis within the first 12 months after IPAA.

• #6 Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572021000100065

  Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review […] This review discusses the most important aspects of the epidemiology, diagnosis, pathogenesis, and treatment of pouchitis. […] The incidence of pouchitis varies over time. At 1, 5 and 10 years, its incidence is 20%, 40% and 50%, respectively. At 30 years after surgery, it may affect 80% of patients. These figures contrast with the low incidence of pouchitis (0-10%) described in patients who underwent the same surgery but due to familial adenomatous polyposis. […] The risk of dysplasia in the pouch is extremely rare when there is no neoplasia or dysplasia before undergoing this surgery. In this regard, a study reported that dysplasia occurred only in 1 % of patients 10 to 15 years after surgery; besides, according to a more recent research, the risk of cancer was 1.3%. On the other hand, when there is dysplasia or cancer before surgery, the risk of neoplasia increases substantially as follows: in the case of perioperative dysplasia, the hazard ratio (HR) is 3.76 (95 % CI: 1.39-10.19), while in patients with previous cancer, it is 24.69 (95 % CI: 9.61-63.42). In these patients, performing endoscopic surveillance of the pouch annually is recommended. On the other hand, the performance of endoscopic surveillance of the pouch, along with biopsies, every 1 to 3 years is recommended in patients with a 10-year history of UC before undergoing ileoanal pouch surgery and with one of following risk factors: chronic pouchitis, cuffitis, family history of colon cancer in first-degree relatives, and primary sclerosing cholangitis. If the aforementioned risk factors are not present, surveillance is performed every 3 years, starting 10 years after the UC diagnosis is reached.

• #7 Diagnosis and Medical Treatment of Acute and Chronic Idiopathic Pouchitis in Inflammatory Bowel Disease

  https://www.mdpi.com/1648-9144/60/6/979

  Pouchitis is the most common complication in these patients, where up to 60% develop one episode of pouchitis in the first two years after UC surgery with IPAA with severe negative impact on their quality of life. […] Of the inflammatory conditions, the most common is pouchitis with an increased prevalence of up to 60% of patients in the 2 years after IPAA. […] The risk of developing pouchitis is increased in patients with primary sclerosing cholangitis. Evidence suggests that the cumulative risk of pouchitis at one, two, five and ten years is 15.5%, 22.5%, 36% and 45.5% in patients without PSC and 22%, 43%, 61% and 79% in patients with concomitant PSC. […] Pouchitis in patients with total proctocolectomy and IPAA for UC is frequent and a significant number of patients develop phenotypes that require multiple courses of antibiotics, long-term antibiotic use or do not respond to antibiotics and need the use of immunosuppressive treatments. Available data regarding therapeutic options in patients with pouchitis are scarce. […] Larger randomized controlled trials for the management of chronic pouchitis should represent a topic of interest for further research.

• #8 IDDF2021-ABS-0117 Prevalence of pouchitis in both ulcerative colitis and familial adenomatous polyposis; a systematic review and meta-analysis | Gut

  https://gut.bmj.com/content/70/Suppl_2/A125

  Pouchitis is a clinically significant complication of ileal pouchanal anastomosis (IPAA) with its prevalence varying in the literature. Pouchitis is thought to occur more commonly in patients with Ulcerative Colitis (UC) than Familial Adenomatous Polyposis (FAP). […] A PRISMA meta-analysis was conducted by searching the Embase, Embase classic and Pubmed databases between 1970 2021 to identify studies that reported the incidence of pouchitis. […] Our analysis showed that in patients with UC; the prevalence of acute pouchitis was 0.18 (95%CI: 0.15-0.22) with a significant heterogeneity of I2= 89% P0.01. The prevalence of chronic pouchitis in UC was found to be 0.13 (95% CI: 0.10-0.18) with a significant heterogeneity of I2=94% P0.01. In FAP the total prevalence of pouchitis was found to be 0.02 (95% CI: 0.00-0.14) with a significant heterogeneity of I2 = 69%, P0.01. The odds ratio of total pouchitis in UC compared with FAP patients was 3.78 (CI: 2.76-5.34, p0.001). […] Our findings support the consensus that the prevalence of pouchitis is higher in UC than in FAP and higher in acute than in chronic. More significantly, our findings suggest that the true prevalence of pouchitis is higher than commonly reported in the literature.

• #9 European Crohn´s and Colitis Organisation – ECCO – DOP35 Increasing incidence of pouchitis among patients undergoing ileal pouch-anal anastomosis between 1996 and 2018: A population-based Danish cohort study

  https://www.ecco-ibd.eu/publications/congress-abstracts/item/dop35-increasing-incidence-of-pouchitis-among-patients-undergoing-ileal-pouch-anal-anastomosis-between-1996-and-2018-a-population-based-danish-cohort-study.html

  Current knowledge regarding the epidemiology of pouchitis is based on highly selected, mostly single-center, patient cohorts. […] Our objective was to prospectively determine the population-based incidence of pouchitis in patients with ulcerative colitis (UC) in the first 2 years after ileal pouch-anal anastomosis (IPAA) and analyze time trends of the incidence of pouchitis. […] The cumulative incidence of pouchitis in the 2 years after IPAA increased throughout the study period, from 40% in 1996-2000, (95% CI:35%-46%) to 55% in 2015-2018, (95% CI:48%-63%, Table 1). […] This first population-based study demonstrated a 15% absolute and 38% relative increase in the incidence of pouchitis among patients undergoing surgery between 1996 and 2018, with the greatest cumulative incidence of pouchitis demonstrated in the most recent era (2015-2018). […] The striking increase in the incidence of pouchitis highlights the need for further research into causes and prevention of pouchitis.

• #10 Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

  https://www.wjgnet.com/2308-3840/full/v13/i1/101226.htm

  Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis. […] To identify potential risk factors for the development of chronic pouchitis. […] Predictors of chronic pouchitis were investigated through a systematic review and meta-analysis. […] Eleven studies with a total of 3722 patients, comprising 513 with chronic pouchitis and 3209 patients without, were included in the final analysis. […] Extraintestinal manifestation, specifically primary sclerosing cholangitis (PSC), and extensive colitis were associated with an increased risk of chronic pouchitis. […] These findings underscore the importance of comprehensive pre-operative assessment and tailored post-operative management strategies. […] Pouchitis is the most frequent complication after ileal pouch anal anastomosis (IPAA) surgery.

• #11 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Pouchitis is a non-specific inflammation of the ileal reservoir, and the most common, inflammatory and long-term, complication after pouch surgery for ulcerative colitis. […] The reported incidence of pouchitis is largely variable because of differences in nature and duration of the follow-up, occurring in up to 50% of the patients 10 years after IPAA in large series from major referral centers. […] Most patients who develop acute pouchitis do so within the first year, but some may suffer their first attack some years following surgery. […] The aetiology of pouchitis is still unknown, and is likely to be multifactorial; it is supposed that a close interaction between the host immune response and the microbiota play a substantial role. […] Reported risk factors for pouchitis include, being a non-smoker extensive UC, backwash ileitis, extraintestinal manifestations (EIMs) especially primary sclerosing cholangitis (PSC), regular use of non-steroidal anti-inflammatory drugs (NSAIDs), and concomitant autoimmune disorders.

• #12 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Use of NSAIDs after pouch surgery postoperatively, is associated with acute and chronic pouchitis. […] A subgroup of patients with pouchitis has concurrent immune-mediated conditions including primary sclerosing cholangitis (PSC), seropositivity for immunoglobulin G4 (IgG4) and infiltration of IgG4-expressing plasma cells in the pouch mucosa. […] Accurate diagnosis and classification are important for appropriate management. […] The diagnosis of pouchitis should not be based only on symptoms assessment; endoscopic evaluation with biopsies of the mucosa of the pouch body and of the afferent limb is the most important tool for the diagnosis and differential diagnosis. […] In a study including consecutive asymptomatic patients after pouch surgery for UC, undergoing surveillance pouchoscopy, incidental abnormal endoscopic and/or histologic findings were common, suggesting the utility of endoscopic surveillance.

• #13

  https://mentoringinibd.com/ibd-dialogue/volume-20/pouchitis/

  A recent review suggests pouchitis is common, with a cumulative probability of 20% at 1 year after pouch formation and up to 40% at 5 years. […] The registry included 5352 patients from 201217 and found a complication rate of 23% and a failure rate of 5%. […] A retrospective study on the management of patients with pouch dysfunction (n=121), found that the most frequent causes of pouchitis were anastomotic leakage (21%), primary idiopathic pouchitis (20%), and functional disorders (20%). […] Around 60% of patients with acute pouchitis develop at least one recurrence and up to 19% develop chronic pouchitis that is refractory to antibiotics. […] The EARNEST trial was the first randomized controlled trial of advanced therapy in chronic pouchitis and investigated the use of intravenous vedolizumab in patients with active CARP after proctocolectomy and IPAA for ulcerative colitis (n=102). […] The evidence for other advanced therapies in the management of chronic pouchitis is limited and mainly anecdotal. […] For pouch dysfunction that is refractory to antibiotics and/or advanced therapies, ensure that all potential causes of pouch dysfunction have been considered and refer for help.

• #14 Incidence, Risk Factors, and Outcomes of Pouchitis and Pouch-related Complications in Patients with Ulcerative Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8552292/

  The cumulative incidence of a new diagnosis of Crohns disease after IPAA for UC was 9.0% (95% CI, 7.2%11%). […] The cumulative incidence of pouch excision among patients with pouchitis was 1.0% (95% CI 0.4% 3.0%). […] Given that approximately one-half of patients will develop pouchitis in the first 2 years after IPAA, gastroenterologists should strongly consider standardized protocols for the assessment and management of patients after IPAA for UC.

• #15

  https://link.springer.com/article/10.1007/s00535-025-02231-1

  Endoscopic phenotypes of pouchitis according to the Chicago Classification have been reported to be associated with poor pouch outcomes in ulcerative colitis (UC). […] The primary endpoints were frequencies of endoscopic phenotypes of the Chicago Classification and their predictability for chronic pouchitis and pouch failure. […] The frequencies of chronic pouchitis and pouch failure were 32% and 4.9%, respectively. […] We demonstrated the predictability of the Chicago Classification for pouch outcomes, and a lower prevalence of pouch-related fistula, resulting in a lower pouch failure risk in our multicenter cohort. […] Our study demonstrated that the Chicago Classification is a useful tool for predicting chronic pouchitis and pouch failure. […] The initial phenotype of inlet involvement, especially ulceration, may also be a warning sign of pouch failure.

• #16

  https://journals.lww.com/ajg/fulltext/2007/09002/surveillance_pouch_endoscopy_for_the_detection_of.933.aspx

  Dysplasia or cancer can still occur in the anal transitional zone (ATZ) or ileal pouch mucosa after IPAA for ulcerative colitis (UC). […] The estimated incidence rates for dysplasia of any grade in the ATZ or pouch mucosa were 0.34% and 1.93% for average-risk and high-risk patients, respectively. […] Surveillance pouch endoscopy is cost-effective for average-risk patients (Q 3 yrs) and for high-risk patients (Q 1 yr), which was sensitive to change in incidence rates.

• #17 SciELO Brazil – DIAGNOSTIC AND MANAGEMENT APPROACH TO POUCHITIS IN INFLAMMATORY BOWEL DISEASE DIAGNOSTIC AND MANAGEMENT APPROACH TO POUCHITIS IN INFLAMMATORY BOWEL DISEASE

  https://www.scielo.br/j/ag/a/TR4Vb4DGXdH6D7Zw4RVHgKg/?lang=en

  Given the increased risk of neoplasia of the pouch, these patients need to enter an endoscopic surveillance program which should be performed every one to two years. […] Patients with a pouch must have a screening endoscopy every one to three years. […] In patients with risk factors, such history of UC for more than 10 years, cuffitis, family history of colorectal cancer or PSC, should have endoscopic surveillance with biopsy every one or two years. […] The risk of malignancies in patients with a pouch is 0.9% at five years and 5.1% at 25 years.

• #18 PWE-052 Current practices in ileal pouch surveillance for ulcerative colitis patients in three london ibd referral centres | Gut

  https://gut.bmj.com/content/66/Suppl_2/A151

  There are no universally accepted guidelines regarding surveillance of IBD patients after ileal pouch-anal anastomosis (IPAA). […] We assessed how frequently pouch surveillance is carried out at our centres. […] 15/126 (12%) had never undergone pouchoscopy for any indication. […] Of the 111 who had, the median interval between pouch surgery and first pouchoscopy was 1.3 years (0.26.4). […] We demonstrated wide variation in endoscopic surveillance of UC-IPAA patients, even amongst experienced clinicians. […] Some patients underwent several pouchoscopies for surveillance, whereas others had none. […] Moreover, endoscopic pouch assessments could be considered incomplete in a proportion of patients with no description of the prepouch ileum or rectal cuff/anal transition zone.

• #19 Current Practices in Ileal Pouch Surveillance for Patients With Ulcerative Colitis: A Multinational, Retrospective Cohort Study. – SORA

  http://openaccess.sgul.ac.uk/111309/

  BACKGROUND AND AIMS: There are no universally accepted guidelines regarding surveillance of ulcerative colitis [UC] patients after restorative proctocolectomy and ileal pouch-anal anastomosis [IPAA]. […] We observed wide variation in surveillance of UC/IBDU-IPAA patients. […] We therefore concur with previous recommendations that pouchoscopy be performed at 1 year postoperatively, to refine risk-stratification based on clinical factors alone.

• #20 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  More recently, a study showed that ulcers and/or erosions were observed in about 20% of asymptomatic patients and were associated with an increased risk of acute pouchitis. […] The most common causes are pelvic sepsis, CARP, CD of the pouch and pouch fistula or sinus. […] Pouchitis is the most common long-term complication of IPAA, and is a syndrome including many different diseases. […] Diagnosis and classification should be accurate for appropriate management; pouch endoscopy is the most effective technique for diagnosis and differential diagnosis.

• #21 Pouchitis Market: Epidemiology, Industry Trends, Share, Size, Growth, Opportunity, and Forecast 2024-2034

  https://www.researchandmarkets.com/reports/5969681/pouchitis-market-epidemiology-industry-trends?srsltid=AfmBOoo2rbqaeKHd9X-ypuZD2ztEBN1p4SFZdn5ICxWkMBSw8TzLISeC

  The 7 major pouchitis markets reached a value of US$ 51.9 Million in 2023. Looking forward, the publisher expects the 7MM to reach US$ 117.6 Million by 2034, exhibiting a growth rate (CAGR) of 9.51% during 2023-2034. […] This report provides an exhaustive analysis of the pouchitis market in the United States, EU5 (Germany, Spain, Italy, France, and United Kingdom) and Japan. This includes treatment practices, in-market, and pipeline drugs, share of individual therapies, market performance across the seven major markets, market performance of key companies and their drugs, etc. […] According to the report the United States has the largest patient pool for pouchitis and also represents the largest market for its treatment. […] The report also provides the current and future patient pool across the seven major markets.

• #22 Pouchitis Market Size, Trends and Forecast 2024-2034

  https://www.imarcgroup.com/pouchitis-market

  The pouchitis market has been comprehensively analyzed in IMARC’s new report titled „Pouchitis Market: Epidemiology, Industry Trends, Share, Size, Growth, Opportunity, and Forecast 2024-2034”. […] According to the report the United States has the largest patient pool for pouchitis and also represents the largest market for its treatment. […] The report also provides the current and future patient pool across the seven major markets. […] What is the number of prevalent cases (2018-2034) of pouchitis across the seven major markets? […] What is the size of the pouchitis patient pool (2018-2023) across the seven major markets? […] What would be the forecasted patient pool (2024-2034) across the seven major markets? […] What are the key factors driving the epidemiological trend of pouchitis? […] What will be the growth rate of patients across the seven major markets?

• #23 Top Published Expert Doctors for Pouchitis

  https://findexpertmd.com/d/Pouchitis?physician=physician

  331 top medical experts on Pouchitis across 32 countries and 23 U.S. states, including 227 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials: at least 35 including 1 Active, 14 Completed, 13 Recruiting.

• #24 Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

  https://www.wjgnet.com/2308-3840/full/v13/i1/101226.htm

  Identifying the risk factors of chronic pouchitis could lead to more personalized patient care, better preoperative counselling, and potential interventions to reduce the risk of chronic pouchitis in patients undergoing IPAA surgery for ulcerative colitis in the future and improve long-term outcomes. […] The most commonly reported complication following IPAA surgery is pouchitis, which can develop in up to 70% of patients within 5 years of surgery. […] However, up to 30% of these patients develop chronic pouchitis, which may be responsive or resistant to antibiotics. […] A systematic review and meta-analysis of existing literature of real-world experience on currently available therapies for chronic pouchitis found that vedolizumab and ustekinumab are effective in treating chronic pouchitis with a good safety profile.

• #25 Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

  https://www.wjgnet.com/2308-3840/full/v13/i1/101226.htm

  The paucity of high-quality studies to date indicates an unmet therapeutic need in the management of chronic pouchitis. […] Hence, identifying risk factors for chronic pouchitis is crucial for categorizing clinical profiles and predicting disease progression. […] Multiple risk factors for the development of chronic pouchitis have been investigated, including smoking history, male gender, extensive colitis, primary sclerosing cholangitis (PSC), and indication of IPAA surgery. […] Our meta-analysis offers a more comprehensive and statistically robust assessment of these risk factors compared to previously published individual cohort or case-control studies. […] Our study corroborates previous findings that extraintestinal manifestations, specifically PSC, are risk factors for chronic pouchitis.

• #26 Pouchitis: Clinical Features, Diagnosis, and Treatment | IJGM

  https://www.dovepress.com/pouchitis-clinical-features-diagnosis-and-treatment-peer-reviewed-fulltext-article-IJGM

  Pouchitis can be classified based on disease duration and clinical course, and response to medical therapy. […] Pouchitis may further be termed, based on response to antibiotic monotherapy, in antibiotic-responsive, antibiotic-dependent (ie, requiring ongoing antibiotic therapy to keep disease in remission), and antibiotic-refractory (ie, not responding to a standard course of antibiotic therapy). […] In 25% of the cases, refractory pouchitis may be due to other conditions, and before a diagnosis of CARP is done, these conditions should be ruled out. […] Diagnosis CD of the pouch can occur at a distance from surgery with an increasing cumulative incidence over time. […] Clostridioides difficile infection (CDI) is more common cause of refractory pouchitis than cytomegalovirus (CMV) infection reaching 11%; CDI in patients who underwent pouch surgery is very often refractory or recurrent.

• #27 Pouchitis – Wikipedia

  https://en.wikipedia.org/wiki/Pouchitis

  The incidence of a first episode of pouchitis at 1, 5 and 10 years post-operatively is 15%, 33%, and 45% respectively.[3][5] […] The most reliable tool for diagnosis is endoscopy combined with histologic features (derived from tissue biopsies obtained during endoscopy).[6] […] Once a diagnosis of pouchitis is made, the condition is further classified. The activity of pouchitis is stratified as: […] The duration of pouchitis is defined as acute (less than or equal to four weeks) or chronic (four weeks or more) and the pattern classified as infrequent (12 acute episodes), relapsing (three or fewer episodes) or continuous. […] A pilot study on the effect of reducing dietary FODMAP intake on bowel function in people without a colon indicates there might be a relation between pouchitis and FODMAP diets.[11]

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