Pouchitis Flashcards
how can pouchitis be classified
antibiotic responsive
antibiotic dependent
antibiotic resistant
what are the secondary causes of pouchitis
Infection - CMV, C.diff
Nsaids
ischaemia
Crohns, IgG4, PSC associated
describe the anatomy of a J pouch
transition zone of cuff efferent limb J tip afferent limb pre pouch ileum
what is the incidence of pouchitis
20-60%
significantly higher in patients with UC vs FAP
what is cuffitis and how is it treated
recurrence of UC in the residual cuff of rectal mucosa
Mx - 5ASA or steroids
when assessing a J pouch endoscopically what should be done
careful assessment of transition zone - cancer almost exclusively occurs here
Biopsies to exclude histological disease
what are RF for pouch neoplasia
past history of FHx of CRC
chronic pouchitis
PSC
what is the recurrence rate after an episode of acute pouchitis
60% have at least 1 other episode
what is the treatment of acute pouchitis (sx <4 weeks)
first line
cipro 500mg bd for 14 days (alt metronidazole 500-1000mg bd or rifaxamin 550mg bd)
if one Abx does not work try another
what is the treatment of chronic pouchitis
Abx but duration of 4 weeks
might have to use Abx in combination if not responding
How are patient with multiple relapses >3 per year managed
maintenance abx
- cipro250-500mg daily
rifaxamina 200mg daily to 500-1000mg bd
How are patients with abx refractory disease Mx
topical 5 ASA for 4 weeks
topical + oral 5asa
may add steroid enema or budesonide orally (9mg for 8 weeks)
immunomodulator +/- biologic
How are patients with PSC/ IgG 4 associated pouchitis Mx
budesonide if non-responsive escalate
When do we survery patients for neoplasia
yrly if history of CRC
1-3 yrly if history of PSC, FHx CRC, chronic pouchitis or cuffitis
3 yearly if non-above
When surveying for neoplasia what is important to remember
neoplasia may not be enodsocpically visible even with enhanced imaging thus biopsies of transition zone must be taken
