Pathogenesis of and unifying hypothesis for idiopathic pouchitis.
Affiliation
School of Medicine and Medical Sciences University College Dublin, St Vincent's University Hospital, Dublin, Ireland. calvincoffey@hotmail.comIssue Date
2009-04MeSH
Anal CanalAnastomosis, Surgical
Anti-Bacterial Agents
Bacteria
Colitis, Ulcerative
Colonic Pouches
Diagnosis, Differential
Humans
Intestinal Mucosa
Metaplasia
Postoperative Complications
Pouchitis
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Pathogenesis of and unifying hypothesis for idiopathic pouchitis. 2009, 104 (4):1013-23 Am. J. Gastroenterol.Journal
The American journal of gastroenterologyDOI
10.1038/ajg.2008.127PubMed ID
19259080Abstract
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
ArticleLanguage
enISSN
1572-0241ae974a485f413a2113503eed53cd6c53
10.1038/ajg.2008.127