Pouchitis is a common long-term complication after ileal pouch anal anastomosis for ulcerative colitis.
Chronic refractory pouchitis is a treatment-resistant condition that affects 5-15% of patients.
Dr C. Calabrese and colleagues from Italy used wireless capsule endoscopy to test the hypothesis of a small bowel involvement. This is a single-blind, prospective, cohort study.
|All pouchitis patients had ileal lesions at capsule endoscopy|
| Alimentary Pharmacology & Therapeutics |
24 patients were examined, and of these, 16 had chronic refractory pouchitis.
The remaining 8 with a macroscopically and histologically normal ileal pouch were considered as control subjects.
All subjects were submitted to the wireless capsule endoscopy procedure and diagnosis of pouchitis was confirmed using the pouchitis disease activity index.
2 weeks before wireless capsule endoscopy, patients underwent a pouch endoscopy and a small bowel follow-through.
Re-examination of the colonic surgical and histological specimens was also performed.
1 patient with chronic pouchitis was excluded because of incomplete bowel cleaning.
At small bowel follow-through, of the 16 patients, 2 subjects (13%) showed only a focal ectasia of the middle ileum and a substenosis of the pouch.
At wireless capsule endoscopy all the 15 evaluable patients with chronic pouchitis (100%) showed diffuse lesions from the duodenum to the ileum consisting of aphthae, erosions, erythema, atrophy, cobblestone and deep/fissural ulcers.
Dr Calabrese concluded that, "This enteropathy needs further research, and wireless capsule endoscopy could be useful to show involvement of the small bowel in patients with chronic pouchitis".