Effect of ileoanal pouch anastomosis and pouchitis on extraintestinal manifestations of ulcerative c

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Effect of ileoanal pouch anastomosis and
pouchitis on extraintestinal manifestations of
ulcerative colitis
10th/11th April 2006

• Sonya Murphy
• Department of Academic Surgery UCC
• Supervisors Mr Adrian OCallaghan
• Professor W.O. Kirwan

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Introduction
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Ulcerative Colitis

• 1859 Samuel Wilks first description of
  "ulcerative colitis" in the London Medical
  Gazette.
• Chronic, episodic, inflammatory disease of the
  large intestine and rectum.
• Incidence 10 20 / 100,000
• Aetiology is largely unknown environmental and
  auto-immune factors are believed to culminate in
  a inflammatory response in a genetically
  pre-disposed person

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Ileoanal Pouch Anastomoses

• Sir Alan Parks, 1976
• Parks pouch ? J Pouch

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Extra-Intestinal Manifestations

• 20-22 of patients
• Aetiology genetic factors and humoral immunity
• EIMs are a risk factor for pouchitis¹

¹Kuisma,J. Järvinen, H. Kahri,J. Färkkilä, M.
Factors associated with disease activity of
pouchitis after surgery for ulcerative colitis
Scandinavian Journal of Gastroenterology , Volume
39, Number 6 / June 2004, 544 548
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Hypothesis
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• Following an Ileoanal Pouch Anastomosis the
  inflammatory focus has been removed, therefore,
  the presence of extraintestinal manifestations
  should decrease

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Aims
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• Investigate the effect if IleoAnal Pouch
  Anastomosis (IPAA) on Extraintestinal
  manifestations
• Examine patient knowledge and understanding of
  EIMs

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Methods
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• Retrospective study, 1985-2005
• HIPE database, clinical nurse specialist
• Questionnaire
• Data Analysed using SPSS 12.0 Software

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• 62 Cases recognised
• 45 responses response rate of 73
• 2 exclusions

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Results
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Population Sample

• average age 42.2

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Extra-Intestinal Manifestations
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• 50 of respondents with pre-IPAA EIMs resolved
  with the formation of a pouch
• 23.2 of respondents had new onset symptoms of
  EIMs after pouch formation

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Pouchitis
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• 75 of people with EIMs (Pre-IPAA) suffered with
  pouchtis
• 80 of those with new onset EIMS post IPAA
  suffered with pouchitis (plt0.05, Chi²4.74)

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Knowledge of Extraintestinal Manifestations
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• 58 of respondents did not know that UC could
  affect parts of the body other than bowel
• 36 who had no knowledge of EIMs had symptoms of
  such

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Conclusions
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• 50 of extra-intestinal manifestations resolved
  with the formation of a pouch
• Pouchitis is a risk factor (plt0.05) for
  developing EIMs following pouch formation
• 58.14 of patients were not told about the EIMs
  of UC
• 36 of patients are suffering with symptoms of
  EIMs but do not know they exist and are not being
  treated

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Summary
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• We have shown in this study that
• Patients are not being told about extraintestinal
  manifestations
• Patients are not being treated for
  extraintestinal manifestations
• IPAA decreases the number of EIMs present before
  pouch formation
• Pouchitis is associated with the development of
  EIMs following IPAA

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Acknowledgements
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• I would like to thank the following people for
  their help in undertaking this study
• Mr Adrian OCallaghan, Department of Surgery CUH
• Professor W.O. Kirwan, Department of Surgery CUH
• Ms Anne Murphy, Clinical Nurse Specialist,
  Department of Surgery CUH