IBD Center, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy.
Colon and Rectal Surgery Division, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy.
United European Gastroenterol J. 2021 Dec;9(10):1157-1167. doi: 10.1002/ueg2.12175. Epub 2021 Nov 29.
Diversion proctocolitis (DP) is a non-specific mucosal inflammation arising in the defunctionalized colon and/or rectum following faecal diversion (colostomy, ileostomy). Differential diagnosis of DP from the underlying disease in patients with inflammatory bowel diseases (IBD) is often unclear. As a result, it might be difficult to undertake any specific treatment. We aimed to systematically review the literature evidence on DP in IBD patients.
For this qualitative systematic review, we searched PubMed, EMBASE and Scopus to identify all studies published until July 2021 including IBD patients affected by DP.
Overall, 37 papers published between 1982 and 2021 were included. A total of 1.211 IBD patients were included: 613 UC (50.6%), 524 CD (43.3%), 66 IBD-unclassified (IBD-U) (5.4%), 8 unspecified patients (0.7%). Most patients with DP are asymptomatic, although inflammation is detectable in almost all patients with a rectal stump. Reduced short-chain fatty acids and an altered microbiome, may trigger mucosal inflammation and have been proposed as causing factors. An increased risk of developing cancer on DP has been reported in patients with a history of previous dysplasia/cancer.
The etiopathogenesis of DP is still unknown. The efficacy of mesalamine, corticosteroids or short-chain fatty acids has not been proven by randomized trials yet. Since the incidence of cancer of the rectal stump can reach 4.5 per 1.000 diverted patients-year, IBD patients undergoing subtotal colectomy with end-ileostomy should undergo close endoscopic surveillance, being eventually counseled for surgery with or without the restoration of the intestinal continuity.
粪流改道（faecal diversion）后，功能性结肠和/或直肠的非特异性黏膜炎症，即 diverted proctocolitis（DP），又称作 diverted proctitis。在炎症性肠病（inflammatory bowel disease，IBD）患者中，DP 与基础疾病的鉴别诊断往往并不明确，因此可能难以进行任何特定的治疗。本研究旨在系统回顾 IBD 患者 DP 的文献证据。
这是一项定性系统回顾，通过检索 PubMed、EMBASE 和 Scopus，我们收集了截至 2021 年 7 月发表的所有研究，纳入患有 DP 的 IBD 患者。
共纳入 37 篇发表于 1982 年至 2021 年的文献，纳入 IBD 患者 1211 例，其中溃疡性结肠炎（ulcerative colitis，UC）613 例（50.6%）、克罗恩病（Crohn's disease，CD）524 例（43.3%）、IBD 未分类（IBD-unclassified，IBD-U）66 例（5.4%）、未明确诊断患者 8 例（0.7%）。尽管几乎所有直肠残端患者都存在炎症，但大多数 DP 患者无症状。短链脂肪酸减少和微生物组改变可能引发黏膜炎症，被认为是致病因素。有研究报道，既往存在异型增生/癌症的 DP 患者发生癌症的风险增加。
DP 的发病机制仍不清楚。目前尚未通过随机对照试验证实美沙拉嗪、皮质类固醇或短链脂肪酸的疗效。由于直肠残端癌的发生率可达 4.5/1000 例/年，因此接受次全结肠切除术和末端回肠造口术的 IBD 患者应接受密切的内镜监测，并最终考虑行手术治疗，是否保留肠连续性视情况而定。
