Approximately 5% of IPAA procedures are performed in patients whose primary diagnosis is revised at some point after surgery from UC to CD. Many had their original colectomy for "fulminant colitis." CD may be the cause of chronic pouch and prepouch inflammation and perianal fistulas. Once the diagnosis is confirmed, therapy is no different from that of pelvic and perianal CD in patients still with a rectum. Infected cavities must be drained, obstruction must be excluded, and medical therapy with antibiotics such as metronidazole (250 to 500 mg 3 times daily) or ciprofloxacin (500 mg twice daily) should be begun.* It is our practice to start immunosuppressive therapy with AZA (2 to 2.5 mg/kg/d) or 6-MP (1.5 mg/kg/d) in CD patients whose conditions do not warrant immediate pouch excision. Open-label experience with the tumor necrosis factor alpha antibody (infliximab) for CD of pouches has been published by Ricart and colleagues (1999). A single infusion of infliximab (5 mg/kg) resulted in a rapid and favorable response in most patients.

Despite the use of powerful immunosuppressive medications in patients with pouchitis, CD of the pouch, or cuffitis, a minority of patients will not respond. The resulting chronic inflammation leads to a scarred, noncompli-ant pouch. In such patients, it may become futile to continue attempts at medical therapy, because the quality of life will clearly be much better after pouch excision and permanent ileostomy.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

Get My Free Ebook

Post a comment