Department of General Surgery, Peking Union Medical College Hospital, Beijing, China.
Inflamm Bowel Dis. 2013 Feb;19(2):404-10. doi: 10.1097/MIB.0b013e31828100ed.
Cuffitis, considered a form of reminiscent ulcerative colitis (UC), is one of the common complications of ileal pouch-anal anastomosis (IPAA) and its disease course has not been systematically characterized. The aim was to examine the disease course of cuffitis in a large historical cohort.
All patients with cuffitis diagnosed based on a combined evaluation of symptom and pouch endoscopy at the initial visit to our Pouchitis Clinic were included. Pouch patients with diagnoses other than cuffitis served as controls. Patients with familial adenomatous polyposis were excluded.
A total of 120 patients with cuffitis were included. The control group consisted of 811 patients (normal pouch, n = 85; irritable pouch syndrome, n = 155; acute pouchitis, n = 170; chronic pouchitis, n = 128; Crohn's disease [CD] of the pouch, n = 185; and surgical complications, n = 88). After a median follow-up of 6 years (interquartile range: 3-10 years) after pouch construction, there were 40 (33.3%) having 5-aminosalicylate (5-ASA)/steroid-responsive cuffitis; 22 (18.3%) having 5-ASA/steroid-dependent cuffitis, and 58 (48.4%) developing 5-ASA/steroid-refractory cuffitis. Further investigation of the 58 patients with refractory cuffitis showed that 19 (32.8%) had CD of the pouch and 14 (24.1%) had surgical complications including fistulae and anastomotic sinuses. There were 16 (13.3%) cuffitis patients who developed pouch failure during the follow-up period.
Cuffitis may represent a spectrum of diseases. In patients with refractory cuffitis, a diagnosis of CD or surgery-associated anal transitional zone complications should be considered.
cuffitis 被认为是回肠贮袋肛门吻合术（IPAA）的常见并发症之一，是一种溃疡性结肠炎（UC）的回忆性表现，其疾病过程尚未得到系统描述。本研究旨在通过对我们的贮袋炎诊所的初始就诊患者进行症状和贮袋内镜联合评估，研究 cuffitis 的疾病过程。
所有 cuffitis 患者均符合初始就诊时症状和贮袋内镜联合评估的诊断标准。以诊断为 cuffitis 的患者为观察组，以诊断为其他疾病的贮袋炎患者为对照组。观察组排除家族性腺瘤性息肉病患者。
共纳入 120 例 cuffitis 患者。对照组包括 811 例患者（正常贮袋 85 例，易激性贮袋综合征 155 例，急性贮袋炎 170 例，慢性贮袋炎 128 例，贮袋炎合并克罗恩病 185 例，手术相关并发症 88 例）。贮袋成形术后中位随访 6 年（四分位间距：3~10 年），其中 40 例（33.3%）为 5-氨基水杨酸/类固醇应答性 cuffitis，22 例（18.3%）为 5-氨基水杨酸/类固醇依赖性 cuffitis，58 例（48.4%）发展为 5-氨基水杨酸/类固醇难治性 cuffitis。进一步分析 58 例难治性 cuffitis 患者的资料，发现 19 例（32.8%）为贮袋炎合并克罗恩病，14 例（24.1%）为手术相关并发症，包括瘘管和吻合口窦道。随访期间 16 例（13.3%）患者发生贮袋炎失败。
cuffitis 可能代表了一组疾病。对于难治性 cuffitis 患者，应考虑诊断为贮袋炎合并克罗恩病或手术相关的肛移行区并发症。
