Endoscopic, Histologic and Symptom Assessment Are Required for the Diagnosis of Pouchitis

Colon 0104

ENDOSCOPIC, HISTOLOGIC AND SYMPTOM ASSESSMENT ARE MANDATORY FOR THE DIAGNOSIS OF POUCHITIS Hagit Tulchinsky 1,2 , Iris Dotan1,3 , Eli Brazowski4, Yaara Dgani3, Zamir Halpern3, Micha Rabau1,2 1Pouch Clinic, 2Department of Surgery B, 3Department of Gastroenterology and Liver Diseases and 4Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Background: Restorative proctocolectomy (RPC) is the operation of choice for ulcerative colitis, with good long-term results. Pouchitis is the most common RPC-related complication, occurring in a significant number of patients depending on duration of follow up and diagnostic criteria. Pouchitis is often diagnosed based on symptoms alone. Aim: To determine whether endoscopic and histologic evaluation are required together with symptom assessment for the diagnosis of pouchitis. Methods: Fifty consecutive patients after RPC seen at the pouch clinic between 2003-2004 underwent clinical assessment, pouch-endoscopy and biopsies. The Pouch Disease Activity Index (PDAI) comprised of independent clinical, endoscopic and histologic severity scores was used. Pouchitis was defined as PDAI7. Results: Twenty-seven patients (54%) had pouchitis with significantly higher clinical, endoscopic and histologic scores compared with 23 (56%) patients without pouchitis. Demographic data were similar between the two groups. Mean time after RPC was 3.83.2 years. Stool frequency was the most common symptom. Erosions were the most common endoscopic finding both in patients with (60%) and without (47%) pouchitis. The three scores: symptoms, endoscopy and histology similarly contributed to total PDAI in 70% of pouchitis patients, and clinical score alone was never a major factor. In contrast, 40% of patients not meeting the PDAI definition of pouchitis had major clinical symptoms. Two thirds of them were refractory to antibiotic treatment, in contrast to 85% response in the pouchitis group. Conclusions: Symptoms alone do not reliably diagnose pouchitis. All PDAI components-clinical, endoscopic and histologic are mandatory to correctly diagnose pouchitis.