IV．Pouchitis

回腸嚢炎は潰瘍性大腸炎（UC）に対する大腸亜全摘・回腸嚢肛門（管）吻合術後に回腸嚢に起こる非特異性炎症である・外科治療成績の向上に伴いクローズアップされてきた病態で，病因は未だ不明であるが，UCの病態と関連があり，腸内細菌の関与が濃厚である．抗菌剤が有効で，多くは一過性であるが，一部に難治例があり，病因・病態の解明とより有効な治療の開発が待たれる．...

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Published in日本大腸肛門病学会雑誌 Vol. 64; no. 10; pp. 834 - 841
Main Authors 中村, 信治, 藤井, 久男, 川崎, 敬次郎, 尾原, 伸作, 中川, 正, 内本, 和晃, 錦織, 直人, 井上, 隆, 中島, 祥介, 小山, 文一, 植田, 剛
Format Journal Article
LanguageJapanese
Published 日本大腸肛門病学会 2011
Subjects
restorative proctocolectomy
回腸嚢炎
潰瘍性大腸炎
Online AccessGet full text
ISSN0047-1801
1882-9619
DOI10.3862/jcoloproctology.64.834

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Abstract 回腸嚢炎は潰瘍性大腸炎（UC）に対する大腸亜全摘・回腸嚢肛門（管）吻合術後に回腸嚢に起こる非特異性炎症である・外科治療成績の向上に伴いクローズアップされてきた病態で，病因は未だ不明であるが，UCの病態と関連があり，腸内細菌の関与が濃厚である．抗菌剤が有効で，多くは一過性であるが，一部に難治例があり，病因・病態の解明とより有効な治療の開発が待たれる．
AbstractList 回腸嚢炎は潰瘍性大腸炎（UC）に対する大腸亜全摘・回腸嚢肛門（管）吻合術後に回腸嚢に起こる非特異性炎症である・外科治療成績の向上に伴いクローズアップされてきた病態で，病因は未だ不明であるが，UCの病態と関連があり，腸内細菌の関与が濃厚である．抗菌剤が有効で，多くは一過性であるが，一部に難治例があり，病因・病態の解明とより有効な治療の開発が待たれる．
Author 中川, 正
藤井, 久男
中村, 信治
小山, 文一
植田, 剛
川崎, 敬次郎
錦織, 直人
中島, 祥介
井上, 隆
尾原, 伸作
内本, 和晃
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  fullname: 小山, 文一
  organization: 奈良県立医科大学消化器・総合外科
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  fullname: 植田, 剛
  organization: 奈良県立医科大学消化器・総合外科
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References 1) Hahnloser D, Pemberton JH, Wolff BG, et al: Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg 94: 333-340, 2007
44) Calabrese C, Gionchetti P, Rizzello F, et al: Short-term treatment with infliximab in chronic refractory pouchitis and ileitis. Aliment Pharmacol Ther 27: 759-764, 2008
8) Smith FM, Coffey JC, Kell MR, et al: A characterization of anaerobic colonization and associated mucosal adaptations in the undiseased ileal pouch. Colorectal Dis 7: 563-570, 2005
7) de Silva HJ, Millard PR, Kettlewell M, et al: Effects of the faecal stream and stasis on the ileal pouch mucosa. Gut 32: 1166-1169, 1991
20) Heuschen UA, Autschbach F, Allemeyer EH, et al: Long-term follow-up after ileoanal pouch procedure: algorithm for diagnosis, classification, and management. Dis Colon Rectum 44: 487-499, 2001
40) Belluzzi A, Serrani M, Roda G, et al: Pilot study: the use of sulfasalazine for the treatment of acute pouchitis. Aliment Pharmacol Ther 31: 228-232, 2010
3) 藤井久男: Pouchitisの実態―アンケート調査結果―. 厚生労働科学研究難治性疾患克服研究事業「難治性炎症性腸疾患に関する調査研究」班 平成13年度研究報告書. 2002, p110-111
26) 佐々木巌: Pouchitisの管理と予防: 「回腸嚢炎の診断基準」. 厚生労働科学研究難治性疾患克服研究事業「難治性炎症性腸疾患に関する調査研究」班 平成16年度研究報告書. 2005, p45-46
12) McLaughlin SD, Walker AW, Churcher C, et al: The bacteriology of pouchitis: a molecular phylogenetic analysis using 16S rRNA gene cloning and sequencing. Ann Surg 252: 90-98, 2010
29) Pardi DS, D'Haens G, Shen B, et al: Clinical guidelines for management of pouchitis. Inflamm Bowel Dis 15: 1424-1431, 2009
19) Sandborn WJ, Tremaine WJ, Batts KP, et al: Pouchitis following ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 69: 409-415, 1994
28) Yu E, Shao Z, Shen B: Pouchitis. World J Gastroenterol 13: 5598-5604, 2007
34) Issacs KL, Sandler RS, Abreu M, et al: Rifaximin for the treatment of active pouchitis: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis 13: 1250-1255, 2007
14) Coffey JC, Rowan F, Burke J, et al: Pathogenesis of and unifying hypothesis for idiopathic pouchitis. Am J Gastroenterol 104: 1013-1023, 2009
18) Warren BF, Shepherd NA: The role of pathology in pelvic ileal reservoir surgery. Int J Colorect Dis 7: 68-75, 1992
2) Beliard A, Prudhomme M: Ileal reservoir with ileo-anal anastomosis: Long-term complications. J Vis Surg 147: e137-e144, 2010
32) 佐々木巌: 回腸嚢炎治療指針案の改訂について. 厚生労働科学研究難治性疾患克服研究事業「難治性炎症性腸疾患に関する調査研究」班 平成22年度研究報告書. 2011, p113-114
21) Shen B, Achkar J, Lashner BA, et al: Irritable pouch syndrome: a new category of diagnosis for symptomatic patients with ileal pouch anal anastomosis. Am J Gastroenterol 97: 972-977, 2002
4) Ikeuchi H, Nakano H, Uchino M, et al: Incidence and therapeutic outcome of pouchitis for ulcerative colitis in Japanese patients. Dig Surg 21: 197-201, 2004
37) Mann SD, Pitt J, Springall RG, et al: Clostridium difficile infection -an unusual cause of refractory pouchitis: report of a case. Dis Colon Rectum 46: 267-270, 2003
42) 味村俊樹, 野澤慶次郎, 松田圭二ほか: 難治性回腸嚢炎に対するprobioticsによる緩解維持療法. 外科治療 94: 301-303, 2006
35) Shen B, Fazio VW, Remzi FH, et al: Combined ciprofloxacin and tinidazole therapy in the treatment of chronic refractory pouchitis. Dis Colon Rectum 50: 498-508, 2007
36) Mimura T, Rizzello R, Helwig U, et al: Four-week open-label trial of metronidazole and ciprofloxacin for the treatment of recurrent or refractory pouchitis. Aliment Pharmacol Ther 16: 909-917, 2002
13) Zella GC, Hait EJ, Glavan T, et al: Distinct microbiome in pouchitis compared to healthy pouches in ulcerative colitis and familial adenomatous polyposis. Inflamm Bowel Dis 17: 1092-1100, 2011
22) Pardi DS, Sandborn WJ: Systemic review: the management of pouchitis. Aliment Pharmacol Ther 23: 1087-1096, 2006
31) Holubar SD, Cima RR, Sandborn WJ, et al: Treatment and prevention of pouchitis after pouch-anal anastomosis for chronic ulcerative colitis (Review). Cochran Library Issue 6, 2010
25) Shen B, Achkar J, Connor JT, et al: Modified pouchitis disease activity index. a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum 46: 748-753, 2003
11) Kohyama A, Ogawa H, Funayama Y, et al: Bacterial population moves toward a colon-like community in the pouch after total proctocolectomy. Surgery 145: 435-447, 2009
5) 藤井久男, 小山文一, 中川, 正ほか: 回腸嚢炎の診断と臨床経過 初期病変の診断を目指して―経過を中心に. 胃と腸 44: 1574-1582, 2009
9) Duffy M, O'Mahony L, Coffey JC, et al: Sulfate-reducing bacteria colonize pouches formed for ulcerative colitis but not for familial adenomatous polyposis. Dis Colon Rectum 45: 374-388, 2002
17) Moskowitz RL, Shepherd NA, Nicholls RJ: An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorect Dis 1: 167-174, 1986
24) Navaneethan U, Shen B: Secondary pouchitis: those with identifiable etiopathogenetic or triggering factors. Am J Gastroenterol 105: 51-64, 2009
43) Araki Y, Mitsuyama K, Nagae T, et al: Leukocytapharesis for the treatment of active pouchitis: a pilot study. J Gastroenterol 43: 571-575, 2008
39) Miglioli M, Barbara L, Di Febo G, et al: Topical administration of 5-aminosalicylic acid: a therapeutic proposal for the treatment of pouchitis. N Engl J Med 320: 257, 1989
41) Gionchetti P, Rizzello F, Poggioli G, et al: Oral budesonide in the treatment of chronic refractory pouchitis. Aliment Pharmacol Ther 25: 1231-1236, 2007
30) Vento P, Lepistö A, Kärkkäinen P, et al: Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis. Colorectal Dis 13: 58-66, 2010
33) Shen B, Achkar J, Lashner BA, et al: A randomized clinical trial of ciprofloxacin and metronidazole to treat acute pouchitis. Inflamm Bowel Dis 7: 301-305, 2001
10) Komanduri S, Gillevet PM, Sikaroodi M, et al: Dysbiosis in pouchitis: evidence of unique microfloral patterns in pouch inflammation. Clin Gastroenterol Hepatol 5: 352-360, 2007
15) Bell AJ, Price AB, Forbes A, et al: Pre-pouch ileitis: a disease of the ileum in ulcerative colitis after restorative proctocolectomy. Colorectal Dis 8: 402-410, 2006
16) 厚生労働科学研究費補助金 難治性疾患克服事業 「難治性炎症性腸管障害に関する調査研究」班 Pouchitis内視鏡診断アトラス 改訂版 平成22年度分担研究報告書. 2011
27) Hurst RD, Molinari M, Chung P, et al: Prospective study of the incidence, timing, and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg 131: 497-502, 1996
6) Lovegrove RE, Tilney HS, Heriot AG, et al: A comparison of adverse events and functional outcomes after restorative proctocolectomy for familial adenomatous polyposis and ulcerative colitis. Dis Colon Rectum 49: 1293-1306, 2006
23) Shen B, Plesec TP, Remer E, et al: Asymmetric endoscopic inflammation of the ileal pouch: a sign of ischemic pouchitis? Inflamm Bowel Dis 16: 836-846, 2010
38) Shen B, Jiang ZD, Fazio VW, et al: Clostridium difficile infection in patients with ileal pouch-anal anastomosis. C1in Gastroenterol Hepatol 6: 782-788, 2008
45) Shen B, Pardi DS, Bennett AE, et al: The efficacy and tolerability of AST-120 (spherical carbon adsorbent) in active pouchitis. Am J Gastroenterol 104: 1468-1474, 2009
References_xml – reference: 32) 佐々木巌: 回腸嚢炎治療指針案の改訂について. 厚生労働科学研究難治性疾患克服研究事業「難治性炎症性腸疾患に関する調査研究」班 平成22年度研究報告書. 2011, p113-114
– reference: 3) 藤井久男: Pouchitisの実態―アンケート調査結果―. 厚生労働科学研究難治性疾患克服研究事業「難治性炎症性腸疾患に関する調査研究」班 平成13年度研究報告書. 2002, p110-111
– reference: 35) Shen B, Fazio VW, Remzi FH, et al: Combined ciprofloxacin and tinidazole therapy in the treatment of chronic refractory pouchitis. Dis Colon Rectum 50: 498-508, 2007
– reference: 20) Heuschen UA, Autschbach F, Allemeyer EH, et al: Long-term follow-up after ileoanal pouch procedure: algorithm for diagnosis, classification, and management. Dis Colon Rectum 44: 487-499, 2001
– reference: 39) Miglioli M, Barbara L, Di Febo G, et al: Topical administration of 5-aminosalicylic acid: a therapeutic proposal for the treatment of pouchitis. N Engl J Med 320: 257, 1989
– reference: 28) Yu E, Shao Z, Shen B: Pouchitis. World J Gastroenterol 13: 5598-5604, 2007
– reference: 44) Calabrese C, Gionchetti P, Rizzello F, et al: Short-term treatment with infliximab in chronic refractory pouchitis and ileitis. Aliment Pharmacol Ther 27: 759-764, 2008
– reference: 4) Ikeuchi H, Nakano H, Uchino M, et al: Incidence and therapeutic outcome of pouchitis for ulcerative colitis in Japanese patients. Dig Surg 21: 197-201, 2004
– reference: 37) Mann SD, Pitt J, Springall RG, et al: Clostridium difficile infection -an unusual cause of refractory pouchitis: report of a case. Dis Colon Rectum 46: 267-270, 2003
– reference: 6) Lovegrove RE, Tilney HS, Heriot AG, et al: A comparison of adverse events and functional outcomes after restorative proctocolectomy for familial adenomatous polyposis and ulcerative colitis. Dis Colon Rectum 49: 1293-1306, 2006
– reference: 22) Pardi DS, Sandborn WJ: Systemic review: the management of pouchitis. Aliment Pharmacol Ther 23: 1087-1096, 2006
– reference: 10) Komanduri S, Gillevet PM, Sikaroodi M, et al: Dysbiosis in pouchitis: evidence of unique microfloral patterns in pouch inflammation. Clin Gastroenterol Hepatol 5: 352-360, 2007
– reference: 19) Sandborn WJ, Tremaine WJ, Batts KP, et al: Pouchitis following ileal pouch-anal anastomosis: a pouchitis disease activity index. Mayo Clin Proc 69: 409-415, 1994
– reference: 24) Navaneethan U, Shen B: Secondary pouchitis: those with identifiable etiopathogenetic or triggering factors. Am J Gastroenterol 105: 51-64, 2009
– reference: 30) Vento P, Lepistö A, Kärkkäinen P, et al: Risk of cancer in patients with chronic pouchitis after restorative proctocolectomy for ulcerative colitis. Colorectal Dis 13: 58-66, 2010
– reference: 34) Issacs KL, Sandler RS, Abreu M, et al: Rifaximin for the treatment of active pouchitis: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis 13: 1250-1255, 2007
– reference: 38) Shen B, Jiang ZD, Fazio VW, et al: Clostridium difficile infection in patients with ileal pouch-anal anastomosis. C1in Gastroenterol Hepatol 6: 782-788, 2008
– reference: 43) Araki Y, Mitsuyama K, Nagae T, et al: Leukocytapharesis for the treatment of active pouchitis: a pilot study. J Gastroenterol 43: 571-575, 2008
– reference: 27) Hurst RD, Molinari M, Chung P, et al: Prospective study of the incidence, timing, and treatment of pouchitis in 104 consecutive patients after restorative proctocolectomy. Arch Surg 131: 497-502, 1996
– reference: 42) 味村俊樹, 野澤慶次郎, 松田圭二ほか: 難治性回腸嚢炎に対するprobioticsによる緩解維持療法. 外科治療 94: 301-303, 2006
– reference: 1) Hahnloser D, Pemberton JH, Wolff BG, et al: Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg 94: 333-340, 2007
– reference: 14) Coffey JC, Rowan F, Burke J, et al: Pathogenesis of and unifying hypothesis for idiopathic pouchitis. Am J Gastroenterol 104: 1013-1023, 2009
– reference: 31) Holubar SD, Cima RR, Sandborn WJ, et al: Treatment and prevention of pouchitis after pouch-anal anastomosis for chronic ulcerative colitis (Review). Cochran Library Issue 6, 2010
– reference: 23) Shen B, Plesec TP, Remer E, et al: Asymmetric endoscopic inflammation of the ileal pouch: a sign of ischemic pouchitis? Inflamm Bowel Dis 16: 836-846, 2010
– reference: 8) Smith FM, Coffey JC, Kell MR, et al: A characterization of anaerobic colonization and associated mucosal adaptations in the undiseased ileal pouch. Colorectal Dis 7: 563-570, 2005
– reference: 18) Warren BF, Shepherd NA: The role of pathology in pelvic ileal reservoir surgery. Int J Colorect Dis 7: 68-75, 1992
– reference: 17) Moskowitz RL, Shepherd NA, Nicholls RJ: An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorect Dis 1: 167-174, 1986
– reference: 9) Duffy M, O'Mahony L, Coffey JC, et al: Sulfate-reducing bacteria colonize pouches formed for ulcerative colitis but not for familial adenomatous polyposis. Dis Colon Rectum 45: 374-388, 2002
– reference: 25) Shen B, Achkar J, Connor JT, et al: Modified pouchitis disease activity index. a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum 46: 748-753, 2003
– reference: 13) Zella GC, Hait EJ, Glavan T, et al: Distinct microbiome in pouchitis compared to healthy pouches in ulcerative colitis and familial adenomatous polyposis. Inflamm Bowel Dis 17: 1092-1100, 2011
– reference: 12) McLaughlin SD, Walker AW, Churcher C, et al: The bacteriology of pouchitis: a molecular phylogenetic analysis using 16S rRNA gene cloning and sequencing. Ann Surg 252: 90-98, 2010
– reference: 45) Shen B, Pardi DS, Bennett AE, et al: The efficacy and tolerability of AST-120 (spherical carbon adsorbent) in active pouchitis. Am J Gastroenterol 104: 1468-1474, 2009
– reference: 41) Gionchetti P, Rizzello F, Poggioli G, et al: Oral budesonide in the treatment of chronic refractory pouchitis. Aliment Pharmacol Ther 25: 1231-1236, 2007
– reference: 21) Shen B, Achkar J, Lashner BA, et al: Irritable pouch syndrome: a new category of diagnosis for symptomatic patients with ileal pouch anal anastomosis. Am J Gastroenterol 97: 972-977, 2002
– reference: 15) Bell AJ, Price AB, Forbes A, et al: Pre-pouch ileitis: a disease of the ileum in ulcerative colitis after restorative proctocolectomy. Colorectal Dis 8: 402-410, 2006
– reference: 40) Belluzzi A, Serrani M, Roda G, et al: Pilot study: the use of sulfasalazine for the treatment of acute pouchitis. Aliment Pharmacol Ther 31: 228-232, 2010
– reference: 16) 厚生労働科学研究費補助金 難治性疾患克服事業 「難治性炎症性腸管障害に関する調査研究」班 Pouchitis内視鏡診断アトラス 改訂版 平成22年度分担研究報告書. 2011
– reference: 36) Mimura T, Rizzello R, Helwig U, et al: Four-week open-label trial of metronidazole and ciprofloxacin for the treatment of recurrent or refractory pouchitis. Aliment Pharmacol Ther 16: 909-917, 2002
– reference: 26) 佐々木巌: Pouchitisの管理と予防: 「回腸嚢炎の診断基準」. 厚生労働科学研究難治性疾患克服研究事業「難治性炎症性腸疾患に関する調査研究」班 平成16年度研究報告書. 2005, p45-46
– reference: 2) Beliard A, Prudhomme M: Ileal reservoir with ileo-anal anastomosis: Long-term complications. J Vis Surg 147: e137-e144, 2010
– reference: 29) Pardi DS, D'Haens G, Shen B, et al: Clinical guidelines for management of pouchitis. Inflamm Bowel Dis 15: 1424-1431, 2009
– reference: 11) Kohyama A, Ogawa H, Funayama Y, et al: Bacterial population moves toward a colon-like community in the pouch after total proctocolectomy. Surgery 145: 435-447, 2009
– reference: 33) Shen B, Achkar J, Lashner BA, et al: A randomized clinical trial of ciprofloxacin and metronidazole to treat acute pouchitis. Inflamm Bowel Dis 7: 301-305, 2001
– reference: 5) 藤井久男, 小山文一, 中川, 正ほか: 回腸嚢炎の診断と臨床経過 初期病変の診断を目指して―経過を中心に. 胃と腸 44: 1574-1582, 2009
– reference: 7) de Silva HJ, Millard PR, Kettlewell M, et al: Effects of the faecal stream and stasis on the ileal pouch mucosa. Gut 32: 1166-1169, 1991
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StartPage 834
SubjectTerms restorative proctocolectomy
回腸嚢炎
潰瘍性大腸炎
Title IV．Pouchitis
URI https://www.jstage.jst.go.jp/article/jcoloproctology/64/10/64_10_834/_article/-char/ja
Volume 64
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ispartofPNX 日本大腸肛門病学会雑誌, 2011, Vol.64(10), pp.834-841
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