Document Detail

Treatment of rectal cuff inflammation (cuffitis) in patients with ulcerative colitis following restorative proctocolectomy and ileal pouch-anal anastomosis.
MedLine Citation:
PMID:  15307872     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice in the majority of patients with ulcerative colitis (UC) who require surgery. To ease the construction of the IPAA and improve functional outcome by minimizing sphincter related stretch injury, a stapling technique is being commonly used in the pouch-anal anastomosis. Despite its advantages, the procedure normally leaves a 1-2 cm of anal transitional zone or rectal cuff, which is susceptible to recurrence of residual UC or cuffitis. Cuffitis can cause symptoms mimicking pouchitis. AIM: To conduct an open-labeled trial of topical mesalamine in patients with cuffitis. METHODS: We treated 14 consecutive patients with cuffitis by giving mesalamine suppositories 500 mg b.i.d. (mean 3.2 months, range 1-9 months). The Cuffitis Activity Index (adapted from the Pouchitis Disease Activity Index) scores and improvement in symptoms of bloody bowel movements and arthralgias were measured as primary and secondary outcomes. RESULTS: All patients had surgery for medically refractory UC. There were significant reductions in the total Cuffitis Activity Index scores after the therapy (11.93 +/- 3.17 vs 6.21 +/- 3.19, p < 0.001). Symptom (3.24 +/- 1.28 vs 1.79 +/- 1.31), endoscopy (3.14 +/- 1.29 vs 1.00 +/- 1.52), and histology (4.93 +/- 1.77 vs 3.57 +/- 1.39) scores each were significantly reduced (p < 0.05). Ninety-two percent of patients with bloody bowel movements and 70% of patients with arthralgias improved after the therapy. No systemic or topical adverse effects were reported. CONCLUSION: Topical mesalamine appears well tolerated and effective in treating patients with cuffitis, with improvement in symptom as well as endoscopic and histologic inflammation.
Bo Shen; Bret A Lashner; Ana E Bennett; Feza H Remzi; Aaron Brzezinski; Jean-Paul Achkar; Jane Bast; Marlene L Bambrick; Victor W Fazio
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  99     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-08-13     Completed Date:  2004-09-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1527-31     Citation Subset:  IM    
Copyright Information:
Copyright 2004 American College of Gastroenterology
Center for Inflammatory Bowel Disease, Departments of Gastroenterology/Hepatology, Anatomic Pathology, and Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
Colitis, Ulcerative / surgery*
Colonic Pouches / adverse effects*
Mesalamine / administration & dosage*
Proctocolectomy, Restorative / adverse effects*
Rectum / pathology*,  surgery
Surgical Stapling / adverse effects
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Suppositories; 89-57-6/Mesalamine

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