Seril Darren N, Yao Qingping, Shen Bo
Departments of *Gastroenterology/Hepatology, and †Rheumatic and Immunologic Disease, The Cleveland Clinic Foundation, Cleveland, Ohio.
Inflamm Bowel Dis. 2014 Feb;20(2):378-88. doi: 10.1097/01.MIB.0000435761.82705.6a.
: Restorative proctocolectomy with ileal pouch-anal anastomosis is commonly used in the management of ulcerative colitis. Inflammation of the ileal pouch reservoir, or pouchitis, is a common complication of ileal pouch-anal anastomosis that is incompletely understood. Risk factors including nonsmoker status and primary sclerosing cholangitis have been linked with pouchitis development, but the etiopathogenesis of pouchitis remains poorly defined. Pouchitis is more commonly a complication of ileal pouch-anal anastomosis performed in patients with ulcerative colitis, and similar to ulcerative colitis, chronic pouchitis is associated with extraintestinal manifestations and other diseases of immune origin, suggesting overlap in the disease pathogenesis. It is becoming apparent that pouchitis encompasses clinically distinct subtypes based on the response or lack of response to antibiotic therapy. There is also emerging evidence of the role of autoimmunity in a subgroup of patients with pouchitis, including patients with concurrent primary sclerosing cholangitis, seropositivity for immunoglobulin G4, or infiltration of immunoglobulin G4-expressing plasma cells in the pouch mucosa. The identification of underlying autoimmunity may have important clinical implications in the diagnosis, subclassification, and management of pouchitis.
回肠储袋肛管吻合术的修复性直肠结肠切除术常用于溃疡性结肠炎的治疗。回肠储袋炎是回肠储袋肛管吻合术的常见并发症，目前对此尚未完全了解。包括非吸烟状态和原发性硬化性胆管炎在内的危险因素与储袋炎的发生有关，但储袋炎的病因发病机制仍不清楚。储袋炎更常见于溃疡性结肠炎患者行回肠储袋肛管吻合术后的并发症，与溃疡性结肠炎相似，慢性储袋炎与肠外表现及其他免疫源性疾病有关，提示疾病发病机制存在重叠。越来越明显的是，根据对抗生素治疗的反应或无反应，储袋炎包括临床上不同的亚型。也有新证据表明自身免疫在一部分储袋炎患者中起作用，包括合并原发性硬化性胆管炎、免疫球蛋白G4血清阳性或储袋黏膜中表达免疫球蛋白G4的浆细胞浸润的患者。潜在自身免疫的识别可能对储袋炎的诊断、亚分类和管理具有重要的临床意义。
