Editorial
Copyright ©The Author(s) 2015.
World J Gastroenterol. Aug 7, 2015; 21(29): 8739-8752
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8739
Table 1 Classification of “pouchitis” according to the etiology
Idiopathic pouchitis
Secondary pouchitis
Infectious
Bacterial pathogens
Clostridium difficile, Campylobacter jejuni, Salmonella typhi, Escherichia coli, Klebsiella, Pseudomonas, others
Fungi: Candida
Viruses: CMV
Ischemic
NSAID-associated
Collagenous
Autoimmune-associated
Crohn’s disease-associated
Other diagnoses
Cuffitis
Irritable pouch syndrome
Table 2 The variety of idiopathic pouchitis classifications
Activity
Active
Inactive
Presentation
Acute < 4 wk duration
Chronic > 4 wk duration
Clinical pattern
Single episode
Infrequent < 4 episodes a year
Relapsing > 4 episodes a year
Continuous
Response to treatment
Responsive
Refractory
Response to antibiotics
Antibiotic-responsive:
Infrequent episodes (< 4 episodes per year) responding to a 2-wk course of a single antibiotic
Antibiotic-dependent
Frequent episodes or persistent episodes of pouchitis requiring long-term, continuous therapy for maintaining remission
Chronic antibiotic-refractory
Not responding to a 4-wk course of metronidazole or ciprofloxacin, requiring prolonged therapy of ≥ 4 wk consisting of 2 or more antibiotics, oral or topical 5-ASA, corticosteroids, AZA/6-MP, or biologics
Table 3 The pouchitis disease activity index
CriteriaScore
Clinical
Stool frequency
Usual postoperative stool frequency0
1-2 stool⁄d > postoperative usual1
3 or more stool⁄d > postoperative usual2
Rectal bleeding
None or rare0
Present daily1
Fecal urgency or abdominal cramps
None0
Occasional1
Usual2
Fever (temperature > 37.8 °C)
Absent0
Present1
Endoscopic findings
Edema1
Granularity1
Friability1
Loss of vascular pattern1
Mucous exudates1
Ulceration1
Histological findings - acute histological inflammation
Polymorphonuclear leucocyte infiltration
Mild1
Moderate without crypt abscess2
Severe with crypt abscess3
Ulceration per low-power field (mean)
< 25%/25%-50%/> 50%1/2/3
Total pouchitis disease activity index (max 18) pouchitis ≥ 7
Table 4 The pouchitis activity score
CriteriaScore
Clinical
Stool frequency/24 h: < 8/8-10/10-13/> 130/2/4/6
Urgency: absent/present0/3
Rectal bleeding: absent/present0/3
Endoscopic findings
Edema: absent/present0/1
Granularity: absent/present0/1
Friability: absent/mild/severe0/1/2
Erythema: absent/mild/severe0/2/3
Mucosal flattening: absent/present0/2
Ulcerations/erosions: absent/mild/severe0/2/3
Histological findings
Acute histological inflammation
Polymorphonuclear leucocyte infiltration0/1/2/3
absent/discrete and patchy/moderate ± crypt abscesses or cryptitis/
extensive ± crypt abscesses or cryptitis
Ulcerations/erosions0/1/2/3
absent/mild and superficial/moderate/extensive
Chronic histological inflammation
Polymorphonuclear leucocyte infiltration0/1/2/3
absent/mild and patchy/moderate/extensive
Villous atrophy0/1/2/3
absent/minimal/partial/subtotal-total
Total pouchitis activity score (max 36)
Pouchitis ≥ 13