Ileal Pouch-Anal Anastomosis.pdf

American Journal of Gastroenterology ISSN 0002-9270 C? 2005 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2005.00278.x Published by Blackwell Publishing CLINICAL REVIEW Clinical Approach to Diseases of Ileal Pouch-Anal Anastomosis Bo Shen, M.D., F.A.C.G.,1 Victor W. Fazio, M.B., M.S.,2 Feza H. Remzi, M.D.,2 and Bret A. Lashner, M.D., F.A.C.G.1 Center for Inflammatory Bowel Disease, 1Departments of Gastroenterology/Hepatology and 2Colorectal Surgery The Cleveland Clinic Foundation, Cleveland, Ohio Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for ulcerative colitis (UC) patients with medically refractory disease or dysplasia. IPAA significantly improves quality of life in UC patients who require surgery. However, certain inflammatory and noninflammatory diseases can develop after the surgery, including pouchitis, Crohn’s disease of the pouch, cuffitis, and irritable pouch syndrome. The etiology and pathogenesis of these disease conditions of IPAA are largely unknown. Accurate diagnosis and classification are important for appropriate management. Endoscopic evaluation is the most important tool for the diagnosis and differential diagnosis. (Am J Gastroenterol 2005;100:2796–2807) INTRODUCTION Ulcerative colitis (UC) is common in the United States, af- fecting at least half million Americans. The incidence of UC and Crohn’s disease (CD) appears to be increasing. Approx- imately 25–33% of patients with UC eventually require to- tal proctocolectomy. Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for UC patients with medically-refractory disease, dysplasia or cancer, and for the majority of patients with familial adenomatous polyposis (FAP) (1, 2). Most UC pa- tients with proctocolectomy are candidates for IPAA. The main contraindications for IPAA include a preoperative di- agnosis of CD, absent or decreased anal sphincter muscle tone, and pelvic