Scientific corner

Efficacy of granulocyte and monocyte apheresis for antibiotic-refractory pouchitis after proctocolectomy for ulcerative colitis: an open-label, prospective, multicentre study

Takayuki Yamamoto 1Toshiaki Tanaka 2Tadashi Yokoyama 3Takahiro Shimoyama 1Hiroki Ikeuchi 4Motoi Uchino 4Toshiaki Watanabe 5 , Therap Adv Gastroenterol. 2017 Feb;10(2):199-206.

GMA has a good safety profile, but its efficacy appears to be limited in the management of chronic refractory pouchitis. However, a large controlled study should be conducted to evaluate the efficacy of GMA therapy in patients with pouchitis at an earlier clinical stage, before the disease has become refractory to conventional medical therapy.

https://pubmed.ncbi.nlm.nih.gov/28203278/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298477/pdf/10.1177_1756283X16679348.pdf

Scientific corner

Pouchitis: a practical guide

A Hillary Steinhart Ofer Ben-Bassat Frontline Gastroenterol 2013 Jul;4(3):198-204. doi: 10.1136/flgastro-2012-100171. Epub 2013 Nov 12.

Up to 30% of patients with ulcerative colitis (UC) will require surgical management. The established surgical procedure of choice is colectomy with ileal pouch-anal anastomosis (IPAA) for most patients. Patients with UC who have undergone IPAA are prone to develop inflammatory and non-inflammatory complications. Up to 50% of patients can be expected to experience at least one episode of pouchitis, and most of these patients will experience at least one additional acute episode within 2 years. In other cases, pouchitis might follow a relapsing-remitting course or a chronically active course. The specific aetiology of pouchitis is unknown and the optimal means of diagnosis and classification of pouchitis is not completely agreed upon. Diagnosis of pouchitis based on symptoms alone has been shown to be non-specific due to the fact that symptoms can originate from a myriad of aetiologies, not necessarily inflammatory in nature. As a result, the diagnosis of pouchitis should generally be based on the appropriate constellation of symptoms, combined with endoscopic and histological assessment. Due to the frequently relapsing course of pouchitis, and the fact that the aetiology and pathogenesis are not entirely clear, the long-term management can sometimes be challenging. This review outlines the features suggestive of deviation from ‘normal’ pouch function and provides an approach to the optimal use of diagnostic modalities and medical therapies to treat pouchitis in its various forms.

https://pubmed.ncbi.nlm.nih.gov/28839726/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369791/

Scientific corner

Leukocytapheresis for the treatment of active pouchitis: a pilot study

Yasumi Araki 1Keiichi MitsuyamaTakaaki NagaeYuji TouMotonori NakagawaYasue IwataniMasakazu HaradaHiroyuki OzasaMichio SataToshihiro Noake, J Gastroenterol. 2008;43(7):571-5.

Background: Pouchitis is a major long-term complication of ileal pouch-anal anastomosis for ulcerative colitis. The aim of this study is to investigate the efficacy of leukocytapheresis for the treatment of active pouchitis. Methods: Eight patients with active pouchitis received leukocytapheresis weekly for 5 weeks in an open-label treatment protocol together with baseline therapy. Results: Patients showed significant improvement in their pouchitis disease activity index scores, from 9.5 (range, 8-10) to 4.0 (range, 2-8) (P < 0.05). Six (75%) of the 8 treated patients achieved remission. No adverse events were observed. Conclusions: Leukocytapheresis therapy could be a new therapeutic strategy for patients with pouchitis after ileal pouch-anal anastomosis for ulcerative colitis. These encouraging results lead us to propose a randomized controlled trial.

https://pubmed.ncbi.nlm.nih.gov/18648745/

Scientific corner

Granulocyte apheresis for pouchitis with arthritis and pyoderma gangrenosum after restorative proctocolectomy for ulcerative colitis: a case report

Ritsuko Yanaru-FujisawaTakayuki MatsumotoShotaro NakamuraShuji KochiMitsuo IidaFutoshi KohdaMinako HirahashiTakashi YaoRyuichi Case Reports Inflamm Bowel Dis. 2005 Aug;11(8):780 DOI: 10.1097/01.mib.0000172558.39767.b7

Our case and the case of Kanekura et al8 suggest that circulating leukocytes may play an important role in the pathogenesis of PG and that GCAP in combination with corticosteroids may be a promising strategy for intractable PG. Furthermore, as has been the case for active UC, GCAP may be a choice for severe pouchitis. An accumulation of data with respect to the effect of GCAP on pouchitis seems to be warranted.

https://pubmed.ncbi.nlm.nih.gov/16043996/

https://academic.oup.com/ibdjournal/article/11/8/780/4685895

Scientific corner

Granulocyte apheresis for pouchitis with arthritis and pyoderma gangrenosum after restorative proctocolectomy for ulcerative colitis: a case report

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