Crohn's of the Pouch: Now What?
Crohn's colitis
ileal pouch anal anastomosis
inflammatory bowel disease
pouch revision
Journal
Clinics in colon and rectal surgery
ISSN: 1531-0043
Titre abrégé: Clin Colon Rectal Surg
Pays: United States
ID NLM: 101084157
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
entrez:
2
1
2023
pubmed:
3
1
2023
medline:
3
1
2023
Statut:
epublish
Résumé
Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is the gold standard surgical treatment for the majority (∼90%) of ulcerative colitis (UC) patients. In cases of carefully selected Crohn's colitis patients without small bowel or perianal involvement an "intentional IPAA" may be a viable option for disease resection and restoration of intestinal continuity. More commonly, Crohn's is incidentally found either in the resection specimen or, more commonly, when inflammatory complications subsequently arise after pouch construction for UC or indeterminate colitis. These incidental Crohn's pouches may be diagnosed early or late period post-IPAA. Crohn's may manifest within the pouch, in the proximal small bowel, and/or distally in the rectal cuff or anus. Like intestinal Crohn's, Crohn's disease of the pouch may be of an inflammatory, fibrostenosing, or fistulizing phenotype. Treatment depends on the phenotype and includes medical treatment, most commonly in the form of tumor necrosis factor inhibitor medications; however, the newer small molecules offer a potential treatment for these patients. Surgery first entails treating the sequelae of Crohn's and is typically staged. In up to 60% of Crohn's pouches, particularly in fistulizing disease and/or recalcitrant perianal disease, the pouch fails and must be defunctioned or excised. In patients with Crohn's pouches in situ long term, outcomes including quality of life are comparable to patients who underwent IPAA for UC.
Identifiants
pubmed: 36591396
doi: 10.1055/s-0042-1758139
pii: 01188
pmc: PMC9797285
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
475-486Informations de copyright
Thieme. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest None declared.
Références
Am Surg. 2016 Oct;82(10):977-981
pubmed: 27779987
Dis Colon Rectum. 2010 Nov;53(11):1487-94
pubmed: 20940596
Dis Colon Rectum. 2001 Jun;44(6):769-78
pubmed: 11391134
Dis Colon Rectum. 2004 Nov;47(11):1808-15
pubmed: 15622572
Dis Colon Rectum. 1991 Jun;34(6):475-7
pubmed: 2036927
Aliment Pharmacol Ther. 2018 Mar;47(5):581-587
pubmed: 29266360
Dis Colon Rectum. 2019 May;62(5):595-599
pubmed: 30614849
Dis Colon Rectum. 2012 Jan;55(1):4-9
pubmed: 22156861
Dis Colon Rectum. 2003 Nov;46(11):1489-91
pubmed: 14605567
Dis Colon Rectum. 2021 Jul 1;64(7):783-804
pubmed: 33853087
Ann Surg. 2008 Oct;248(4):608-16
pubmed: 18936574
Inflamm Bowel Dis. 2019 Aug 20;25(9):1569-1576
pubmed: 30810748
J Crohns Colitis. 2021 Jun 22;15(6):960-968
pubmed: 33300546
Rev Esp Enferm Dig. 2003 Jul;95(7):465-70, 459-64
pubmed: 14515846
Lancet Gastroenterol Hepatol. 2022 Jan;7(1):69-95
pubmed: 34774224
Dis Colon Rectum. 2001 Aug;44(8):1137-42; discussion 1142-3
pubmed: 11535853
Dis Colon Rectum. 2005 Aug;48(8):1542-9
pubmed: 15937625
Clin Gastroenterol Hepatol. 2012 May;10(5):507-12.e1
pubmed: 21963956
J Gastrointest Surg. 2017 Jan;21(1):56-61
pubmed: 27832426
Br J Surg. 2005 Oct;92(10):1270-6
pubmed: 15988792
Inflamm Bowel Dis. 2009 Sep;15(9):1337-42
pubmed: 19266572
Expert Rev Gastroenterol Hepatol. 2013 May;7(4):307-21; quiz 322
pubmed: 23639089
Dis Colon Rectum. 2021 Feb 1;64(2):217-224
pubmed: 33315714
BMJ Open Gastroenterol. 2017 Feb 8;4(1):e000127
pubmed: 28243458
Inflamm Bowel Dis. 2017 May;23(5):781-790
pubmed: 28301429
Mod Pathol. 2015 Jan;28 Suppl 1:S30-46
pubmed: 25560598
Arch Pathol. 1970 Jan;89(1):20-9
pubmed: 5410405
Lancet. 1996 Mar 30;347(9005):854-7
pubmed: 8622390
Arch Surg. 1969 Aug;99(2):223-31
pubmed: 5794896
J Gastrointest Surg. 2019 Mar;23(3):571-579
pubmed: 30097964
Inflamm Bowel Dis. 2009 Feb;15(2):163-70
pubmed: 18798573
Dis Colon Rectum. 1995 Jan;38(1):51-4
pubmed: 7813345
Dis Colon Rectum. 2009 Feb;52(2):187-92
pubmed: 19279410
Colorectal Dis. 2021 Jan;23(1):34-51
pubmed: 32810915
Dis Colon Rectum. 2004 Oct;47(10):1613-9
pubmed: 15540289
Int J Colorectal Dis. 2017 Oct;32(10):1517-1518
pubmed: 28698974
J Crohns Colitis. 2017 Dec 4;11(12):1507-1508
pubmed: 29106505
Aliment Pharmacol Ther. 2009 Mar 1;29(5):519-26
pubmed: 19183338
Clin Gastroenterol Hepatol. 2006 Jan;4(1):81-9; quiz 2-3
pubmed: 16431309
Am J Gastroenterol. 2003 Oct;98(10):2239-44
pubmed: 14572574
Colorectal Dis. 2020 Apr;22(4):439-444
pubmed: 31710407
Dis Colon Rectum. 2020 Jan;63(1):117-120
pubmed: 31804276
J Crohns Colitis. 2017 Jan;11(1):77-83
pubmed: 27466172
Inflamm Bowel Dis. 2017 Jan;23(1):E5-E6
pubmed: 27930413
Dis Colon Rectum. 1991 Oct;34(10):857-60
pubmed: 1914717
Aliment Pharmacol Ther. 2008 May;27(9):759-64
pubmed: 18298639
Dis Colon Rectum. 2022 Jul 1;65(7):e743-e744
pubmed: 35333802
Inflamm Bowel Dis. 2015 Jun;21(6):1443-58
pubmed: 25989341
Inflamm Bowel Dis. 2019 Mar 14;25(4):767-774
pubmed: 30295784
Inflamm Bowel Dis. 2010 Feb;16(2):243-9
pubmed: 19637335
Dis Colon Rectum. 2020 Jun;63(6):823-830
pubmed: 32384407
Br J Surg. 1975 Nov;62(11):893-900
pubmed: 1191951
Dis Colon Rectum. 2011 Nov;54(11):1347-54
pubmed: 21979177
Inflamm Bowel Dis. 2015 Nov;21(11):2658-72
pubmed: 26422516
Colorectal Dis. 2019 Feb;21(2):209-218
pubmed: 30444323
Inflamm Bowel Dis. 2010 Nov;16(11):1940-6
pubmed: 20848480
Dis Colon Rectum. 1999 Jan;42(1):96-101
pubmed: 10211527
Dis Colon Rectum. 1996 Aug;39(8):893-8
pubmed: 8756845
J Crohns Colitis. 2021 Oct 7;15(10):1605-1620
pubmed: 34160593
Crohns Colitis 360. 2020 Jul;2(3):otaa039
pubmed: 32744536
Dis Colon Rectum. 2018 May;61(5):532-536
pubmed: 29630001
J Am Coll Surg. 2009 Mar;208(3):390-9
pubmed: 19318001
Dis Colon Rectum. 2012 Feb;55(2):115-21
pubmed: 22228152
Dis Colon Rectum. 2007 Sep;50(9):1450-9
pubmed: 17665259
Inflamm Bowel Dis. 2020 Jun 18;26(7):1079-1086
pubmed: 31587035
Dis Colon Rectum. 2022 Jan 1;65(1):76-82
pubmed: 34882630
Aliment Pharmacol Ther. 2010 Apr;31(7):745-53
pubmed: 20047579
Dis Colon Rectum. 1997 Mar;40(3):263-9
pubmed: 9118738
Ann Surg. 1980 Sep;192(3):319-24
pubmed: 7416829
Dis Colon Rectum. 1991 Aug;34(8):653-7
pubmed: 1855421
Inflamm Bowel Dis. 2013 Jan;19(1):30-6
pubmed: 22467562
Aliment Pharmacol Ther. 2003 May 15;17(10):1263-71
pubmed: 12755839
Dis Colon Rectum. 2021 Feb 1;64(2):143-144
pubmed: 33315705
Colorectal Dis. 2017 Aug;19(8):e279-e287
pubmed: 28614620
Dis Colon Rectum. 2011 Jan;54(1):15-20
pubmed: 21160308
Clin Colon Rectal Surg. 2019 Jul;32(4):280-290
pubmed: 31275075
PLoS One. 2019 Feb 28;14(2):e0213108
pubmed: 30818349
J Pediatr Surg. 2016 Jul;51(7):1181-6
pubmed: 26876089
Dis Colon Rectum. 2008 Jan;51(1):100-8
pubmed: 18085333
Gastroenterol Rep (Oxf). 2018 Aug;6(3):184-188
pubmed: 30151202
Gut. 1993 Oct;34(10):1384-8
pubmed: 8244106
Inflamm Bowel Dis. 2019 Aug 20;25(9):1474-1480
pubmed: 30698715
Surgery. 1978 Mar;83(3):252-8
pubmed: 628888