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    Pathogenesis of and unifying hypothesis for idiopathic pouchitis.

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    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
    Issue Date
    2009-04
    MeSH
    Anal Canal
    Anastomosis, Surgical
    Anti-Bacterial Agents
    Bacteria
    Colitis, Ulcerative
    Colonic Pouches
    Diagnosis, Differential
    Humans
    Intestinal Mucosa
    Metaplasia
    Postoperative Complications
    Pouchitis
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    Citation
    Pathogenesis of and unifying hypothesis for idiopathic pouchitis. 2009, 104 (4):1013-23 Am. J. Gastroenterol.
    Journal
    The American journal of gastroenterology
    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
    ISSN
    1572-0241
    ae974a485f413a2113503eed53cd6c53
    10.1038/ajg.2008.127
    Scopus Count
    Collections
    Cork University Hospital

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