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Introduction
Since its description in 1979 by Parks and Nicholls, restorative proctocolectomy has become the gold-standard for those suffering from ulcerative colitis who require surgical treatment. The procedure successfully restores quality of life in the vast majority of patients and, in experienced hands, has a very low risk of serious perioperative complications. Following restorative proctocolectomy, approximately 95% of ulcerative colitis patients rate their quality of life as good or excellent and would recommend the procedure to a family member or loved ones who required surgery. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - June 7, 2017 Category: Gastroenterology Authors: David Dietz Source Type: research

Role of Surgery in Patients with Pouchitis
Restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) has been an ideal surgical option for patients with chronic ulcerative colitis (UC) and familial adenomatous polyposis for nearly four decades. In most cases, patients enjoy excellent quality of life with a durable surgical and functional result, avoiding the need for a lifelong ileostomy.Despite great success, patients with IPAA may suffer from several pouch-related complications that are a challenge for the patient and surgeon. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 25, 2017 Category: Gastroenterology Authors: Sherief Shawki, Jean H. Ashburn Source Type: research

Classification, differential diagnosis, and diagnosis of pouchitis
Evaluation of patients with ileal pouch-anal anastomosis after total proctocolectomy who present with symptoms suggestive of pouchitis requires a systematic approach. Although idiopathic pouchitis is the most common cause of symptoms, evaluation for possible secondary causes of pouch inflammation and for potential disease mimickers is essential. After appropriate testing and assessement of response to treatment, disease can be classified based on response to antibiotics and as idiopathic or secondary. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 24, 2017 Category: Gastroenterology Authors: Jean-Paul Achkar Source Type: research

When “pouchitis” isn׳t pouchitis: Crohn׳s disease and surgical complications
Restorative proctocolectomy with ileal pouch-anal anastomosis is the definitive operation of choice for the surgical treatment of patients with ulcerative colitis that is refractory to medical therapy or with dysplasia. However, pouch dysfunction due to inflammatory and non-inflammatory diseases frequently affect patients after surgery and have a significant impact on quality of life. Accurate diagnosis is important to guide further therapy and it is essential to differentiate pouchitis from Crohn ׳s disease or surgical complications. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 24, 2017 Category: Gastroenterology Authors: David Liska, Jeffery Mino Source Type: research

Incidence, Prevalence, and Risk Factors for Pouchitis
Pouchitis is a complication of restorative proctocolectomy and ileal pouch-anal anastomosis surgery in patients who undergo the procedure for treatment of inflammatory bowel disease or familial adenomatous polyposis. Patients can present with increased stool frequency, urgency, fecal seepage and abdominal cramps. The reported cumulative frequency rates of pouchitis 10 years after IPAA surgery range from 23 –60% in IBD patients and 0–11% in FAP patients. Although the pathogenesis of pouchitis is unclear, several risk factors for pouchitis have been identified including extra intestinal manifestations of inflammatory bow...
Source: Seminars in Colon and Rectal Surgery - May 24, 2017 Category: Gastroenterology Authors: Winnie Szeto, Francis A. Farraye Source Type: research

Etiology and pathogenesis of pouchitis
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgery for Ulcerative colitis (UC) and Familial adenomatous polyposis (FAP). While this surgical therapy is effective and results in good clinical outcomes and quality of life,1 patients experience complications, the most common of which is pouchitis. While most pouchitis is considered idiopathic, there is mounting evidence that pouchitis results from aberrant immune response to the bacterial populations found in the pouch in a genetically predisposed patient. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 24, 2017 Category: Gastroenterology Authors: Jessica R. Philpott Source Type: research

Classification, differential diagnosis and diagnosis of pouchitis
Evaluation of patients with ileal pouch-anal anastomosis after total procotocolectomy who present with symptoms suggestive of pouchitis requires a systematic approach. Although idiopathic pouchitis is the most common cause of symptoms, evaluation for possible secondary causes of pouch inflammation and for potential disease mimickers is essential. Based on appropriate testing and response to treatment, disease can be classified based on response to antibiotics and as idiopathic or secondary. A systematic approach and the use of different modalities of testing including pouch endoscopy, pathology and imaging, should lead to ...
Source: Seminars in Colon and Rectal Surgery - May 24, 2017 Category: Gastroenterology Authors: Jean-Paul Achkar Source Type: research

Treatment of Acute Pouchitis
Acute pouchitis is a common disease that affects many patients with an ileal pouch-anal anastomosis. The management of acute pouchitis remains largely empiric with the mainstay of therapy being the antibiotics ciprofloxacin and metronidazole. Probiotics may have a role in the primary and secondary prophylaxis of acute pouchitis. In addition, there is modest data that probiotics are effective in the treatment of mild acute pouchitis. There is limited data for other treatments of acute pouchitis including oral and rectal budesonide and butyrate enemas. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 24, 2017 Category: Gastroenterology Authors: John F. Sullivan, Jeffry A. Katz Source Type: research

Treatment of Chronic and Refractory Pouchitis
Chronic and refractory pouchitis are the most challenging phenotypes of pouch inflammation, which represent the worst end of the disease spectrum of pouchitis. There are multiple factors are associated with the development and disease course of chronic and refractory pouchitis. Those factors include the use non-steroidal anti-inflammatory drugs, Clostridium difficile infection, cytomegalovirus infection, presence of concurrent immune-mediated disorders, and pouch ischemia. The identification of those factors helps direct proper therapy. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 24, 2017 Category: Gastroenterology Authors: Bo Shen Source Type: research

When “pouchitis” isn′t pouchitis: crohn′s disease and surgical complications
Restorative proctocolectomy with ileal pouch-anal anastomosis is the definitive operation of choice for the surgical treatment of patients with ulcerative colitis that is refractory to medical therapy or with dysplasia. However pouch dysfunction due to inflammatory and non-inflammatory diseases frequently affect patients after surgery and have a significant impact on quality of life. Accurate diagnosis is important to guide further therapy and it is essential to differentiate pouchitis from Crohn ′s disease or surgical complications. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - May 24, 2017 Category: Gastroenterology Authors: David Liska, Jeffery Mino Source Type: research

High-resolution anoscopy: Procedure and findings
High-resolution anoscopy (HRA) using a colposcope or operating microscope with 5% acetic acid and Lugol ׳s solutions was developed to identify abnormal epithelial changes such as high-grade squamous intraepithelial lesions (HSIL) and other lesions associated with human papillomavirus (HPV). It is hypothesized that targeted treatment of HSIL will prevent progression to cancer. HRA has become more acce pted in clinical practice especially for populations considered at risk for anal cancer including those who are immunocompromised and men who have sex (MSM). (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Naomi Jay Source Type: research

Ablative therapies for the treatment of anal high-grade squamous intraepithelial lesions
Anal HSIL is the precursor lesion of anal squamous cell carcinoma. The exact rate of cancer progression from HSIL is not clear, but likely approaches 10% in immunocompromised individuals. Just as excision and destruction of cervical dysplasia has been shown to significantly decrease the risk of cervical cancer, several studies have shown a reduced incidence of anal cancer after targeted ablation of HSIL. Given the morbidity of anal mapping and wide local excision, we cannot justify this treatment method, especially since recurrence is common. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Joseph P. Terlizzi, Stephen E. Goldstone Source Type: research

High-resolution anoscopy: Is it necessary in the management of anal epithelial neoplasia
The prevalence of anal cancer has more than doubled in the United States over the past 30 years. Consequently, there is a need to develop effective screening, treatment, and surveillance programs for patients at increased risk for anal cancer. Many of these approaches have been borrowed from cervical cancer due to the shared pathology involving the human papillomavirus and successful screening and surveillance methods developed with the use of high-resolution magnification. However, there is limited evidence to support the use of high-resolution anoscopy for populations at increased risk for anal cancer. (Source: Seminars ...
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Justin T. Brady, Bona Ko, Sharon L. Stein Source Type: research

Human papillomavirus infection and its role in the pathogenesis of anal cancer
The incidence of anal cancer has been increasing among both men and women in the general population since the 1970s, and is more common among women than men. Like cervical cancer, anal cancer is associated with human papillomavirus (HPV) infection and is preceded by a precursor lesion, anal high-grade squamous intraepithelial lesions (HSIL) that may take decades to progress to anal cancer. Groups at particularly high risk of anal cancer include immunosuppressed individuals, particularly those with HIV infection, men who have sex with men (MSM), and women with a history of cervical or vulvar HSIL or cancer. (Source: Seminar...
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Joel Palefsky Source Type: research

HPV-associated Disease of the Anal Canal: A Pathology Primer
Anal cancer is a rare disease. Screening for it in high-risk populations is based on the model borrowed from cervical cancer screening with cytology and high resolution anoscopy-guided biopsy. Squamous cell carcinoma of the anus is associated with oncogenic HPVs, particularly type 16. Squamous intraepithelial lesions (SIL) are graded on both anal cytology and histology using 2 tiers. Low-grade SIL is reflective of a productive HPV infection; high-grade SIL is the potential precancer. High-risk HPV testing may not be an efficient screening or triage tool given the high prevalence of the virus in populations targeted for ana...
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Teresa M. Darragh Source Type: research