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Thread: Pouchitis from Ileal Reservoir

  1. #1

    Pouchitis from Ileal Reservoir

    Anybody suffering from pouchitis?

    I'm often suffering from what I believe are they symptoms of a nasty UTI, only to find no bacteria growing in the urine culture indicating an infection.

    I'm a C5-6 quad that had a continent ileal conduit urinary diversion surgery performed by Dr. Shlomo Raz, UCLA in 1996. (similar to Kock or Indiana pouch, aka bladder augmentation, neobladder).

    Some research I found below:

    RESEARCH - KOCK POUCH - Ileal Urine Pouch
    Another complication is pouchitis, an inflammation of the mucous membrane of the pouch. Symptoms include loose stools and sometimes bleeding. Pouchitis is treated with antibiotics, and the symptoms usually disappear within a week. (http://alumnus.caltech.edu/~pls/kock/)




    RESEARCH - POUCHITIS, INFLAMATION GI AND DIET
    Pouchitis is inflammation of the ileal pouch (an artificial rectum surgically created out of ileal gut tissue in patients who have undergone a colectomy), which is created in the management of patients with ulcerative colitis, indeterminate colitis, FAP, or, rarely, other colitides.[1][2]
    A variety of pathophysiological mechanisms have been proposed for pouchitis, but the precise pathogenesis (biological cause) remains unknown.[citation needed] A pilot study on the effect of reducing dietary FODMAP intake on bowel function in patients without a colon ran by Croagh C, Shepherd SJ, Berryman M, Muir JG, Gibson PR indicates there might be a relation between Pouchitis and FODMAP content of diets.[3]
    The incidence of a first episode of pouchitis at 1, 5 and 10 years post-operatively is 15%, 33% and 45% respectively.[2][4]
    Patients with pouchitis typically present with bloody diarrhea, urgency in passing stools, or discomfort while passing stools. The loss of blood and/or dehydration resulting from the frequent stools will frequently result in nausea. Extreme cramping and pain can occur with pouchitis.
    Endoscopy in patients with pouchitis usually reveals erythematous pouch mucosa, loss of pseudocolonic vasculature or other architecture, and friability of the mucosa. Biopsies show evidence of inflammatory cells or red blood cells in the lamina propria.

    Treatment[edit]

    There is no clinically approved treatment for pouchitis.[5] First line treatment is usually with antibiotics, specifically with ciprofloxacin and metronidazole.[6] Ampicillin or Piperacillin can also be considered as alternatives to empiric Ciprofloxacin and metronidazole). Administration of metronidazole at a high daily dose of 20 mg/kg can cause symptomatic peripheral neuropathology in up to 85% of patients. This can be a limiting factor in the use of maintenance metronidazole to suppress chronic pouchitis.[7][8]
    Other therapies which have been shown to be effective in randomised clinical trials include probiotic therapy, the application of which usually begins as soon as any antibiotic course is completed so as to re-populate the pouch with beneficial bacteria. Biologics, such as anti-TNF antibodies, may also be useful but the evidence for their use is largely anecdotal. In addition, discussion by patients using related internet forums appears to give evidence of benefits (again, after cessation of antibiotics) from certain diets, such as the Specific Carbohydrate Diet, Paleolithic Diet, and Low FODMAP Diet. In particular, attention has been drawn to the exclusion of complex carbohydrates, as well as other foods with high starch content (such as grains, rice, and potatoes) and certain dairy products including milk and soft cheese.[9][10]

    Research[edit]

    Antisense inhibitors which target the inflammatory process have been used to treat Pouchitis in clinical trials.[11] Antisense inhibitors function by binding to messenger RNA (mRNA) produced by a gene and deactivating it, effectively turning that gene "off".[12] Specifically applied to pouchitis, antisense inhibitors would be used to switch off the inflammatory process.[11]



    https://en.wikipedia.org/wiki/Pouchitis




  2. #2
    I am not sure what you are asking. Is it possible to restate it another way?
    ckf

  3. #3
    Does anybody who had a neobladder, made from ill or other colon tissue, have experience with pouchitis?

    I believe I may have been experiencing an infection of the pouch tissue as a UTI. I have all the symptoms of a painful UTI, but the culture doesn't grow bacteria. Years ago, a doctor suggested it was interstitial cystitis.

    in addition, at the same time, I experience a lot of the bowel issues mentioned in pouchitis reviews - lots of mucous and bloody stools.

  4. #4
    Here is a consensus statement on the treatment of pouchitis, but it refers to those used to treat colitis, so may not be completely valid for your situation.

    http://www.cochrane.org/CD001176/IBD...tion-pouchitis

    (KLD)

  5. #5
    Senior Member
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    I have a Kock Pouch [continent cutaneous urinary diversion] from the mid 1980's. Like you I am also a quad C5-C6. I do on occasion experience intense pain in may abdomen over the bladder. I call this bladder pain "pouchitis". When I have this intense pain I also experience difficulty catheterizing. The color, smell and opacity of my urine may additionally be different. The urologists are reluctant to prescribe antibiotics because the urine cultures do not reveal an infection. They recommend increasing water intake, more frequent catheterization and frequent hand washing. Call the clinic again if the symptoms persist. This past year I demanded that the do a CT scan because I would get the dry heaves every morning after drinking my morning coffee. The CT results revealed heavy stone burden in each kidney. The stones were surgically removed in July and August. I still get an occasional flair-up of abdominal/bladder pain. I can tolerate the pain, but difficulty cathing always scares me. Sometimes it takes 15-20 minutes with multiple re-insertions of the catheter to empty my bladder. Maybe you should consider having an ultrasound of your bladder and kidneys or an CT scan to investigate the possibility of urinary stones.

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