The relief Sarah, 25, felt after a surgeon removed her colon and she began to recover from the devastating effects of ulcerative colitis turned out to be short-lived. Not quite a year later, she developed pouchitis. She began to experience many of the symptoms she’d had before surgery.
According to Chicago’s Rush University Medical Center, pouchitis is an inflammation of the lining of the ileoanal pouch created to hold bowel movements in patients whose colon – the large intestine – has been removed due to ulcerative colitis or familial adenomatous polyposis. Doctors estimate that nearly a third of individuals who have had their colons removed and who have had an internal pouch constructed develop pouchitis at some point.
Statistics show that the longer a patient has had a pouch, the greater the chance of developing pouchitis. Patients with immunologic skin disease, severe inflammatory joint disease, or a history of primary sclerosing face an elevated risk. So do smokers. While some individuals experience only one attack of pouchitis, others have them on a recurrent basis.
The Mayo Clinic indicates that patients can develop this inflammation if they have either an ileoanal pouch (J pouch) or a continent ileostomy (Koch pouch). Both of these pouches are constructed from the patient’s small intestine and eliminate the need to wear an external appliance to collect waste.
Signs and Symptoms
Ironically, the symptoms of this disorder frequently resemble those of ulcerative colitis. Patients typically experience diarrhea, intestinal bleeding, joint pain, increased stool frequency, and abdominal pain. Some suffer from fever and dehydration.
Doctors rate the severity of pouchitis using a standard scale:
Mild to moderately active. Signs include increased stool frequency, infrequent incontinence, and some urgency.
Severely active. The patient needs to be in the hospital to treat dehydration and frequent incontinence.
Acute. The attack has lasted less than four weeks.
Chronic. Pouchitis has been present for more than four weeks.
Remission. The individual isn’t experiencing symptoms.
The medical team treating a patient with this disorder typically includes gastroenterologists, radiologists, colorectal surgeons, and pathologists.
Diagnosis and Treatment
Physicians use multiple examinations to arrive at a diagnosis of pouchitis. The most common are endoscopies to take a look at the inside of the pouch, imaging to rule out Crohn’s disease, and biopsies. Some patients also require monitoring for symptoms deemed to be precancerous.
Although this inflammation is annoying and uncomfortable, most patients respond to a one- to two-week course of antibiotics. The drugs most commonly used are metronidazole and ciprofloxacin.
If this treatment proves ineffective, doctors have a number of additional options. They include topical mesalamine administered as a suppository or an enema, oral and topical steroids as well as budesonide, and immunosuppressive medications like infliximab (brand name: Remicade). Many patients who suffer from pouchitis eat yogurt, which contains probiotics. These are live organisms that occur naturally in the digestive tract. Doctors recommend that those who are so lactose intolerant that they can’t eat yogurt on a regular basis take probiotic capsules.
One of the many factors surgeons consider before agreeing to remove a patient’s colon is how the surgery might improve the individual’s lifestyle. Despite the inconvenience of pouchitis, most patients who have internal pouches consider their quality of life better than it was prior to the procedure. When all medical treatment fails, surgeons can cure pouchitis by converting the pouch to a traditional ileostomy.