Management of pouch related symptoms in patients who underwent ileal pouch anal anastomosis surgery for adenomatous polyposis

doi:10.12998/wjcc.v9.i32.9847

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World Journal of Clinical Cases

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World J Clin Cases. Nov 16, 2021; 9(32): 9847-9856
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9847

Management of pouch related symptoms in patients who underwent ileal pouch anal anastomosis surgery for adenomatous polyposis

Ophir Gilad, Guy Rosner, Eli Brazowski, Revital Kariv, Nathan Gluck, Hana Strul

Ophir Gilad, Guy Rosner, Revital Kariv, Nathan Gluck, Hana Strul, Department of Gastroenterology and Hepatology, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel

Eli Brazowski, Department of Pathology, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel

Author contributions: Gilad O, Gluck N and Strul H participated in study design, data acquisition, analysis and interpretation; Gluck N and Strul H contributed equally as senior co-authors; Brazowski E reviewed pathology specimens and participated in data analysis and critical revision of article; Kariv R and Rosner G participated in data analysis and critical revision of manuscript.

Institutional review board statement: This study is registered at Tel-Aviv Medical Center Trial Registry, and was approved by the Tel-Aviv Medical Center Helsinki Committee. The registration identification number is 0518-14-TLV.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: None of conflict of interest.

Data sharing statement: None.

Corresponding author: Ophir Gilad, MD, Doctor, Department of Gastroenterology and Hepatology, Tel-Aviv Sourasky Medical Center, Weizman 6, Tel Aviv 6423906, Israel. ophir.gilad@gmail.com

Received: June 12, 2021
Peer-review started: June 12, 2021
First decision: June 30, 2021
Revised: July 23, 2021
Accepted: September 23, 2021
Article in press: September 23, 2021
Published online: November 16, 2021
Processing time: 150 Days and 15.7 Hours

ARTICLE HIGHLIGHTS

Research background

Total proctocolectomy with ileal pouch anal anastomosis is performed in adenomatous polyposis syndromes patients to prevent the development of colon cancer. Pouch surgery has a major impact on quality of life - causing increased number of bowel movements and abdominal pain.

Research motivation

Unlike inflammatory bowel disease patients, data regarding response to different treatment modalities targeting pouch-related disorders in adenomatous polyposis patients is scarce.

Research objectives

This study aimed to assess clinical, endoscopic and histologic response to various treatment modalities used in the therapy of pouch related disorders.

Research methods

Files of adenomatous polyposis patients followed prospectively were retrospectively reviewed for initiation of various therapies. Symptoms and endoscopic and histologic signs of pouch inflammation before and after treatment were assessed. Pouchitis disease activity index and its subscores were calculated.

Research results

Overall, intervention was associated with symptomatic relief, mainly decreasing abdominal pain. Daily bowel movements decreased from a mean of 10.3 to 9.3. Mean overall and clinical PDAI scores decreased from 2.58 to 1.94 and from 1.3 to 0.87, respectively. Dietary modifications decreased abdominal pain. Probiotics effectively decreased daily bowel movements, overall and clinical PDAI. While other therapies had minimal or no effects.

Research conclusions

Adenomatous polyposis patients benefit from dietary modifications and probiotics that improve their pouch-related symptoms but respond minimally to anti-inflammatory and antibiotic treatments

Research perspectives

Adenomatous polyposis patients respond differently to pouch related symptoms than ulcerative colitis patients. Dietary modification and probiotics should be considered first line treatment of pouch related disorders in this population.