Digest This - Special Edition 2008 - (Page 5)

Digestive Disease institute Digestive Disease institute’s pouchitis clinic gains Worldwide Reputation When the Digestive Disease Institute opened its Pouchitis Clinic in 2002, physicians treated about 100 patients. Since then, the number of patients treated has ballooned by more than 100 percent every year. “The Pouchitis Clinic is seeing 600 to 800 patients a year, not all with pouchitis,” says Cleveland Clinic gastroenterologist Bo Shen, MD. “Sixty percent of our patients come from outside ohio and from other nations. We now have the largest practice in the world and the only one of its kind in the United States.” Since 1983, DDI has performed more than 3,700 protocolectomies with ileal pouch-anal anatomosis (IPAA), commonly known as pelvic pouch surgeries. For about 30 percent of ulcerative colitis patients, standard medical treatment fails to control their disease. These patients undergo IPAA, the surgical resection of the colon and rectum. Using about 15 inches of the small intestines, surgeons construct an ileal pouch, or J-pouch, in which the stool is stored. This surgery also is performed on patients that have ulcerative colitis with dysplasia and patients with familial adenomatous polyposis. IPAA has significantly improved the quality of life for thousands of patients. However, 10 years after surgery some patients develop inflammation of the pouch (called pouchitis) or other pouch conditions. Patients with pouchitis often present with symptoms similar to ulcerative colitis, such as diarrhea, crampy abdominal pain, increased stool frequency, dehydration and joint pain. Other patients develop cuffitis, irritable pouch syndrome and even Crohn’s disease. Because pouchitis and other pouch disorders are difficult to diagnose and treat, the Pouchitis Clinic has been instrumental in researching and developing accurate diagnostic criteria, diagnostic classification system, management algorithms, cost-effective evaluation of symptomatic patients and examining the physiology of the pouch with barostat measurements. What’s more, Cleveland Clinic continuously explores treatment options such as balloon dilation and endoscopic needle knife treatment of pouch strictures, 5-aminosalicylic acid suppositories for cuffitis, innovative antibiotic, probiotic, and carbon microsphere regimen for pouchitis, and amitriptyline for irritable pouch syndrome. More recently, Cleveland Clinic researchers showed that Dr. Bo Shen Normal pouch patient: pouch alterations in commensal bacteria and mucosal immunity (such as toll-like receptors and Paneth cell defensins) are involved with the earliest pathogenetic events of acute Normal pouch patient Neo-terminal Ileum pounchitis, chronic pouchitis and Crohn’s disease of the pouch. Their research has been funded by the national Institutes of Health, Broad Foundation, and American College of Gastroenterology. Because of its leadership position in this field, the Pouchitis Clinic continues to develop a worldwide reputation. To keep up with demand, plans are under way to expand services to treat more patients. “over the next few years, we expect Pouchitis: pouch Pouchitis: Neoterminal ileum the number of patient visits to increase to more than 1,000 a year,” says Dr. Shen. The Pouchitis Clinic was founded by Dr. Shen, together with his surgical colleagues, Victor Fazio, MD, Feza Remzi, MD, and Ian Lavery, MD. Dr. Fazio, Chairman of the Cleveland Clinic’s Digestive Disease Institute, pioneered the use of innovative techniques that allow patients to avoid the need for colostomies or ileostomy. For more information, email digestthis@ccf.org clevelandclinic.org /digestthis InVESTIGATIonS {5} http://www.clevelandclinic.org/digestthis

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Digest This - Special Edition 2008 Table of Contents Investigations Institute Overview Innovations Staff Research

Digest This - Special Edition 2008

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