Pathogenesis of and unifying hypothesis for idiopathic pouchitis.

Hdl Handle:
http://hdl.handle.net/10147/201214
Title:
Pathogenesis of and unifying hypothesis for idiopathic pouchitis.
Authors:
Coffey, J Calvin; Rowan, Fiachra; Burke, John; Dochery, Neil G; Kirwan, William O; O'Connell, P Ronan
Affiliation:
School of Medicine and Medical Sciences University College Dublin, St Vincent's University Hospital, Dublin, Ireland. calvincoffey@hotmail.com
Citation:
Pathogenesis of and unifying hypothesis for idiopathic pouchitis. 2009, 104 (4):1013-23 Am. J. Gastroenterol.
Journal:
The American journal of gastroenterology
Issue Date:
Apr-2009
URI:
http://hdl.handle.net/10147/201214
DOI:
10.1038/ajg.2008.127
PubMed ID:
19259080
Abstract:
Ileal pouch-anal anastomosis is the procedure of choice in the surgical management of refractory ulcerative colitis. Pouchitis affects up to 60% of patients following ileal pouch-anal anastomosis for ulcerative colitis. It overlaps significantly with ulcerative colitis such that improvements in our understanding of one will impact considerably on the other. The symptoms are distressing and impinge significantly on patients' quality of life. Despite 30 years of scientific and clinical investigation, the pathogenesis of pouchitis is unknown; however, recent advances in molecular and cell biology make a synergistic hypothesis possible. This hypothesis links interaction between epithelial metaplasia, changes in luminal bacteria (in particular sulfate-reducing bacteria), and altered mucosal immunity. Specifically, colonic metaplasia supports colonization by sulfate-reducing bacteria that produce hydrogen sulfide. This causes mucosal depletion and subsequent inflammation. Although in most cases antibiotics lead to bacterial clearance and symptom resolution, immunogenetic subpopulations can develop a chronic refractory variant of pouchitis. The aims of this paper are to discuss proposed pathogenic mechanisms and to describe a novel mechanism that combines many hypotheses and explains several aspects of pouchitis. The implications for the management of both pouchitis and ulcerative colitis are discussed.
Item Type:
Article
Language:
en
Description:
Ileal pouch-anal anastomosis is the procedure of choice in the surgical management of refractory ulcerative colitis. Pouchitis affects up to 60% of patients following ileal pouch-anal anastomosis for ulcerative colitis. It overlaps significantly with ulcerative colitis such that improvements in our understanding of one will impact considerably on the other. The symptoms are distressing and impinge significantly on patients' quality of life. Despite 30 years of scientific and clinical investigation, the pathogenesis of pouchitis is unknown; however, recent advances in molecular and cell biology make a synergistic hypothesis possible. This hypothesis links interaction between epithelial metaplasia, changes in luminal bacteria (in particular sulfate-reducing bacteria), and altered mucosal immunity. Specifically, colonic metaplasia supports colonization by sulfate-reducing bacteria that produce hydrogen sulfide. This causes mucosal depletion and subsequent inflammation. Although in most cases antibiotics lead to bacterial clearance and symptom resolution, immunogenetic subpopulations can develop a chronic refractory variant of pouchitis. The aims of this paper are to discuss proposed pathogenic mechanisms and to describe a novel mechanism that combines many hypotheses and explains several aspects of pouchitis. The implications for the management of both pouchitis and ulcerative colitis are discussed.
MeSH:
Anal Canal; Anastomosis, Surgical; Anti-Bacterial Agents; Bacteria; Colitis, Ulcerative; Colonic Pouches; Diagnosis, Differential; Humans; Intestinal Mucosa; Metaplasia; Postoperative Complications; Pouchitis
ISSN:
1572-0241

Full metadata record

DC FieldValue Language
dc.contributor.authorCoffey, J Calvinen
dc.contributor.authorRowan, Fiachraen
dc.contributor.authorBurke, Johnen
dc.contributor.authorDochery, Neil Gen
dc.contributor.authorKirwan, William Oen
dc.contributor.authorO'Connell, P Ronanen
dc.date.accessioned2012-01-10T11:52:08Z-
dc.date.available2012-01-10T11:52:08Z-
dc.date.issued2009-04-
dc.identifier.citationPathogenesis of and unifying hypothesis for idiopathic pouchitis. 2009, 104 (4):1013-23 Am. J. Gastroenterol.en
dc.identifier.issn1572-0241-
dc.identifier.pmid19259080-
dc.identifier.doi10.1038/ajg.2008.127-
dc.identifier.urihttp://hdl.handle.net/10147/201214-
dc.descriptionIleal pouch-anal anastomosis is the procedure of choice in the surgical management of refractory ulcerative colitis. Pouchitis affects up to 60% of patients following ileal pouch-anal anastomosis for ulcerative colitis. It overlaps significantly with ulcerative colitis such that improvements in our understanding of one will impact considerably on the other. The symptoms are distressing and impinge significantly on patients' quality of life. Despite 30 years of scientific and clinical investigation, the pathogenesis of pouchitis is unknown; however, recent advances in molecular and cell biology make a synergistic hypothesis possible. This hypothesis links interaction between epithelial metaplasia, changes in luminal bacteria (in particular sulfate-reducing bacteria), and altered mucosal immunity. Specifically, colonic metaplasia supports colonization by sulfate-reducing bacteria that produce hydrogen sulfide. This causes mucosal depletion and subsequent inflammation. Although in most cases antibiotics lead to bacterial clearance and symptom resolution, immunogenetic subpopulations can develop a chronic refractory variant of pouchitis. The aims of this paper are to discuss proposed pathogenic mechanisms and to describe a novel mechanism that combines many hypotheses and explains several aspects of pouchitis. The implications for the management of both pouchitis and ulcerative colitis are discussed.en
dc.description.abstractIleal pouch-anal anastomosis is the procedure of choice in the surgical management of refractory ulcerative colitis. Pouchitis affects up to 60% of patients following ileal pouch-anal anastomosis for ulcerative colitis. It overlaps significantly with ulcerative colitis such that improvements in our understanding of one will impact considerably on the other. The symptoms are distressing and impinge significantly on patients' quality of life. Despite 30 years of scientific and clinical investigation, the pathogenesis of pouchitis is unknown; however, recent advances in molecular and cell biology make a synergistic hypothesis possible. This hypothesis links interaction between epithelial metaplasia, changes in luminal bacteria (in particular sulfate-reducing bacteria), and altered mucosal immunity. Specifically, colonic metaplasia supports colonization by sulfate-reducing bacteria that produce hydrogen sulfide. This causes mucosal depletion and subsequent inflammation. Although in most cases antibiotics lead to bacterial clearance and symptom resolution, immunogenetic subpopulations can develop a chronic refractory variant of pouchitis. The aims of this paper are to discuss proposed pathogenic mechanisms and to describe a novel mechanism that combines many hypotheses and explains several aspects of pouchitis. The implications for the management of both pouchitis and ulcerative colitis are discussed.-
dc.language.isoenen
dc.subject.meshAnal Canal-
dc.subject.meshAnastomosis, Surgical-
dc.subject.meshAnti-Bacterial Agents-
dc.subject.meshBacteria-
dc.subject.meshColitis, Ulcerative-
dc.subject.meshColonic Pouches-
dc.subject.meshDiagnosis, Differential-
dc.subject.meshHumans-
dc.subject.meshIntestinal Mucosa-
dc.subject.meshMetaplasia-
dc.subject.meshPostoperative Complications-
dc.subject.meshPouchitis-
dc.titlePathogenesis of and unifying hypothesis for idiopathic pouchitis.en
dc.typeArticleen
dc.contributor.departmentSchool of Medicine and Medical Sciences University College Dublin, St Vincent's University Hospital, Dublin, Ireland. calvincoffey@hotmail.comen
dc.identifier.journalThe American journal of gastroenterologyen
dc.description.provinceMunster-

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