Frequency, Clinical Features and Factors Associated with Pouchitis after Proctocolectomy with Ileo-Pouch-Anal Anastomosis in Patients with Ulcerative Colitis: A Latin-American Country Retrospective-Cohort Study

Abstract

Background: Pouchitis is the most common complication of proctocolectomy with ileo-pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). No previous study in Mexico has evaluated this issue; our aim was to evaluate its frequency, clinical characteristics and factors associated with its presence in Mexican patients with UC and IPAA. Methods: Retrospective-cohort study including 70 patients with histopathological diagnosis of UC and IPAA between 1983 and 2014 from inflammatory bowel disease clinic of a tertiary care center. The statistical analysis used descriptive statistics, chi-square and Fisher's exact test for categorical variables and Student's t test for numeric variables. Univariate analysis was performed to identify the factors associated. Results: Patients presenting with pouchitis accounted for 48.6%. From the 34 cases, 12 (35.3%) had inactive pouchitis; 7 (20.6%) active acute pouchitis; 15 (44.1%) chronic active pouchitis. On average, pouchitis occurred 5.37 years after IPPA. Factors probably associated with its occurrence were the presence of autoimmune concomitant diseases (ACDs; p = 0.06, OR 4.40, 95% CI 0.84-22.9) and extra-intestinal manifestations (EIMs; p = 0.05, OR 2.53, 95% CI 0.96-6.64), which was also probably associated with chronic active pouchitis (p = 0.06, OR 0.31, 95% CI 0.07-1.31). Conclusions: The frequency of pouchitis is high in Mexican UC patients after IPAA. ACDs and EIMs were probably associated with its development.

Meta‐analysis of the association of extraintestinal manifestations with the development of pouchitis in patients with ulcerative colitis

“…No relevant RCTs were retrieved. Nine and 11 observational studies were selected for the analysis of chronic pouchitis and overall pouchitis respectively in relation to EIMs ( Table S1 , supporting information), and six and ten studies respectively in relation to PSC ( Table S2 , supporting information). One study included both ulcerative colitis and familial polyposis.…”

Systematic review with meta‐analysis: a history of smoking is not associated with a higher risk of pouchitis

“…Of the 15 manuscripts, 12 were retrospective studies, 4,[12][13][14][15][20][21][22][23][24][25][26] 2 were prospective 27,28 and 1 was case-control. 29 Twelve studies included ulcerative colitis patients only [12][13][14][15][20][21][22][23][24][25][26][27] ; three studies included both ulcerative colitis and indeterminate colitis patients. 4,28,29 A total of 2,276 IPAA patients were included in the systematic review and meta-analysis.…”

“…Three studies have shown that smoking may have a protective benefit, 13,[26][27][28] one study has shown a harmful effect 15 and eleven studies have failed to show statistically significant differences in pouchitis rates between smokers and nonsmokers. 4,12,14,16,[20][21][22][23][24][25]29 Notably, all except two of these studies were retrospective and sample sizes varied widely, from 10 to 353 subjects.…”

“…Yamamoto-Furusho et al 24 "Clinical symptoms such as increased stool frequency, liquid stool, abdominal cramping, urgency, tenesmus, discomfort, fever or extraintestinal manifestation exacerbation; endoscopic and pathological findings were considered for the diagnosis of pouchitis at least 3 months after ileal pouch-anal anastomosis"…”

Lower fecal pH may be a novel indicator of pouchitis after IPAA in patients with FAP or metachronous Lynch syndrome

“…The incidence rate of pouchitis after IPAA ranges from 30% to 50% . Patients with pouchitis often present with many nonspecific symptoms, such as increased stool frequency, urgency, incontinence, nocturnal seepage, abdominal cramping, pelvic discomfort, and arthralgia . In some cases, the diagnosis of pouchitis is somewhat intricate because relatively mild symptoms are not necessarily associated with severe endoscopic or histological pouch inflammation.…”