Description

There continues to be controversy regarding the surgical treatment of ulcerative colitis, even more so in this era of biologic therapy. Patients failing medical management will still be treated with colectomy, but now will commonly go to the OR with some biologic agent having been given. Data looking at complications and outcomes associated with surgery and biologic use is difficult to interpret due to the preselected nature of this group of patients, their variable degree of wellbeing at the time of surgery, the variable phenotype of the illness itself and a multitude of differing biologics now being used. However, with time and increasing experience an evolving consensus is emerging, especially insofar as patients undergoing the IPAA procedure. Surgeons need to be aware of factors that can improve or worsen surgical complications associated with the IPAA procedure in patients treated with biologics.

Once the patient undergoes definitive IPAA reconstruction, too often the enigmatic complication of pouchitis will occur. Depending on study and duration of follow up, up to 50% of patients will suffer the signs and symptoms of pouchitis within two years of IPAA creation. Pouchitis suggests itself to be (like IBD) the consequence of the combined effects of genetic predisposition and noxious enteric agents but is very much more responsive to medications, especially antibiotics than the original ulcerative colitis. However, there is, like IBD, a spectrum of pouchitis severity that demands a measured approach with differing therapies based on the specifics of presentation. Though antibiotics may work on mild pouchitis, more severe forms require more aggressive therapy including possibly biologic therapy. The surgeon should be aware of the varying forms and causes of pouchitis, to then be able to institute the appropriate therapy.

Moderators: Walter A. Koltun, MD
Speakers: Samuel Eisenstein, MD, Matthew Mutch, MD

Credit Hours Available: 1 AMA PRA Category 1 Credit(s)™
Release Date: November 8, 2018
Reviewed Date: January 2021
CME Expires: November 8, 2023