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Diagnosis and Differential Diagnosis of Crohn’s Disease of the Ileal Pouch

  • Large Intestine (B Cash, Section Editor)
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Abstract

Approximately 20%–30% of patients with ulcerative colitis will eventually require colectomy despite recent advances in medical therapy. Ileal pouch-anal anastomosis has become the surgical treatment of choice. A subset of patients with ileal pouches can develop Crohn’s disease or a Crohn’s-disease-like condition of the ileal pouch after surgery. Diagnosis, differential diagnosis, and management of Crohn’s disease of the ileal pouch have been challenging. A combined assessment of clinical history, endoscopy, histology, abdominal/pelvic imaging, and examination under anesthesia is often necessary for accurate diagnosis, disease classification, management, and prognosis. A multidisciplinary approach with gastroenterologists, colorectal surgeons, gastrointestinal pathologists, and radiologists is advocated.

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Abbreviations

ASCA:

anti-Saccharomyces cerevisiae

ATZ:

anal-transitional zone

CD:

Crohn’s disease

FAP:

familial adenomatous polyposis

GI:

gastrointestinal

IBD:

inflammatory bowel disease

IBDU:

inflammatory bowel disease unclassified

IC:

indeterminate colitis

IPAA:

ileal pouch-anal anastomosis

NSAIDs:

non-steroidal anti-inflammatory drugs

PSC:

primary sclerosing cholangitis

PVF:

pouch-vaginal fistula

TNFα:

tumor necrosis factor α

UC:

ulcerative colitis

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Disclosure

Bo Shen, MD, has received honoraria from Abbott Laboratories, Aptalis, Optimer, and Prometheus Laboratories.

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Authors and Affiliations

  1. Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China

    Yue Li & Bin Wu

  2. Department of Gastroenterology/Hepatology-Desk A31, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Yue Li & Bo Shen

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  1. Yue Li
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  2. Bin Wu
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  3. Bo Shen
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Correspondence to Bo Shen.

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Li, Y., Wu, B. & Shen, B. Diagnosis and Differential Diagnosis of Crohn’s Disease of the Ileal Pouch. Curr Gastroenterol Rep 14, 406–413 (2012). https://doi.org/10.1007/s11894-012-0282-4

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  • DOI: https://doi.org/10.1007/s11894-012-0282-4

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