Acute Severe Ulcerative Colitis Is Associated With an Increased Risk of Acute Pouchitis.
Inflamm Bowel Dis
; 29(12): 1907-1911, 2023 Dec 05.
Article
em En
| MEDLINE
| ID: mdl-36939632
ABSTRACT
BACKGROUND:
Pouchitis occurs in up to 80% of patients after total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) and has been associated with microbial and host-related immunological factors. We hypothesized that a more robust immune response at the time of colectomy, manifested by acute severe ulcerative colitis (ASUC), may be associated with subsequent acute pouchitis.METHODS:
This was a retrospective cohort analysis of all patients with UC or indeterminate colitis complicated by medically refractory disease or dysplasia who underwent TPC with IPAA at Mount Sinai Hospital between 2008 and 2017 and at least 1 subsequent pouchoscopy. Acute pouchitis was defined according to the Pouchitis Disease Activity Index. Cox regression was used to assess unadjusted relationships between hypothesized risk factors and acute pouchitis.RESULTS:
A total of 416 patients met inclusion criteria. Of the 165 (39.7%) patients who underwent urgent colectomy, 77 (46.7%) were admitted with ASUC. Acute pouchitis occurred in 228 (54.8%) patients a median of 1.3 (interquartile range, 0.6-3.1) years after the final surgical stage. On multivariable analysis, ASUC (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.04-2.17) and a greater number of biologics precolectomy (HR, 1.57; 95% CI, 1.06-2.31) were associated with an increased probability of acute pouchitis, while older age at colectomy (HR, 0.98; 95% CI, 0.97-0.99) was associated with a decreased probability. Time to pouchitis was significantly less in patients admitted with ASUC compared with those not (P = .002).CONCLUSION:
A severe UC disease phenotype at the time of colectomy was associated with an increased probability of acute pouchitis.
In a retrospective cohort analysis of 416 patients, acute severe ulcerative colitis at the time of colectomy was significantly associated with subsequent acute pouchitis. The risk of pouchitis may be driven by immune activation and disease severity precolectomy.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Colite Ulcerativa
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Proctocolectomia Restauradora
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Colite
/
Pouchite
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Bolsas Cólicas
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Inflamm Bowel Dis
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos