J-Pouch Candidacy

Hi all,

I am new to these forums....I am the partner of a ten year sufferer of UC. He has been able to keep his flares largely under control with Asacol (oral and enema) and occasional Prednisone treatment for what seem to have been, up to this point, pretty mild flares.

about a month ago after a trip to the Caribbean, he wound up in the hospital with the worst flare of his life. It started very uncharacteristically, with vomiting, fever, and other flu-like symptoms, and then moved down and evolved into a flare (normally his flares come on very gradually and he is able to mitigate them with an increase in enema dosage and attention to diet).

Nothing is helping this time. He spent five days in the hospital on IV prednisone (60m) and pain meds. Since his release he has not shown any improvement, despite trying probiotics and very carefully monitoring his diet along with an ongoing prednisone dose of 40m/day. He is up all night in the bathroom in pain and things don't seem to be improving.

This morning he met with his doctor to discuss options. The doc is advocating Imuran/Remicade as the best option. My BF and I are both scared to go the immunosupressant route (due to potential long term side effects) and he wants to try taking up smoking in moderation again to see if that might help (it has put him in remission numerous times before). They also discussed surgery and what options he might have surrounding that.

Here's my question. The doc told him he might not be a candidate for J-Pouch and might only be a candidate for removal with an ostomy bag for the rest of his life. Is anyone familiar with why someone may or may not be a candidate for J-Pouch? From what he told me, it sounds like the doc said his case could be too severe for J-Pouch, but it seems like if that's a last resort option for most people, they must be a pretty severe case when they get to that point.

If anyone has additional information, I would really appreciate it.

I am very sorry that your partner is having such a horrible flare. I hope he is on the mend soon! Did your partner ask why the doctor felt the j-pouch would not be a good option?
According to my surgeon there are a number of health conditions that could make J-pouch surgery a poor option. Candidates that should examine other options are: "people who are elderly or who have severe mental health problems, Crohn's disease, or damaged anal sphinctures." "It is also not a good choice for people with indeterminate colitis (colitis that may or may not be caused by Crohn's disease), colorectal cancer or mesenteric desmoid tumors..."
The best idea would be to get a second opinion, preferably from a colorectal surgeon.
Was he also treated with Cipro or Flagyl? Both antibiotics are very effective for intestinal infections that may occur with a flare. The vomiting and fever precipitating the flare may indicate an infection.
Thank you very much for being so supportive of your partner. Uc is nasty.
Szm

Sorry to hear of your partner's troubles.
I had a flare like that about 10 years ago. which landed me in the hosp on IV steroids, like your partner.I was terrified of more meds but chose imuran rather than surgery.
Imuran has had no side effects on me whatsoever and has given me my life back, My GI spent much time tweaking the dose and doing lots of blood work for the first 6 months or so. I am now on Asocol and Imuran, both of which have excellent safety profiles.
Now the flares are milder, life is so much better, and I avoided surgery altogether.
best of luck to you and your partner during this difficult time.