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Diffuse gastroduodenitis and pouchitis associated with ulcerative colitis.

Hiroki Ikeuchi¹, Kazutoshi Hori, Takashi Nishigami

¹Second Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan. ikeuci2s@hyo-med.ac.jp

World Journal of Gastroenterology

|September 29, 2006

Summary

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This case study details ulcerative colitis (UC) affecting the stomach and duodenum, treated successfully with mesalazine and vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) pouchitis.

Area of Science:

Gastroenterology
Inflammatory Bowel Disease Research
Clinical Case Studies

Background:

Ulcerative colitis (UC) typically affects the colon, but rare cases involve upper gastrointestinal tract.
Ileal J-pouch anal anastomosis is a surgical option for UC patients.
Pouchitis, inflammation of the ileal pouch, can occur post-surgery.

Observation:

A 29-year-old woman with an ileal J-pouch presented with epigastric pain, nausea, diarrhea, and fever.
Endoscopic and duodenographic findings revealed lesions in the stomach, duodenum, and J-pouch, resembling UC.
The patient developed catheter-related infection with methicillin-resistant Staphylococcus aureus (MRSA).

Findings:

Gastroduodenal lesions showed pathogenesis similar to colonic UC.

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Symptomatic remission of gastroduodenal lesions was achieved with mesalazine and omeprazole.

Pouchitis was initially treated with ciprofloxacin, but vancomycin was effective against MRSA and improved symptoms.

Implications:

This case highlights the possibility of upper GI involvement in UC.
Successful management involved addressing both UC-related gastroduodenal lesions and MRSA pouchitis.
The findings support a multimodal treatment approach for complex UC presentations.