Perioperative Factors During Ileal Pouch-Anal Anastomosis Predict Pouchitis

Abstract

Patients with symptomatic, biopsy-confirmed pouchitis have worse long-term outcomes than those without pouchitis. This complication is associated with specific pre- and intraoperative factors. Histological pouchitis incidentally found on surveillance biopsy in asymptomatic patients is of no clinical relevance and does not influence outcome. Identification of these preoperative factors associated with the subsequent development of pouchitis will strengthen patient counseling and may facilitate risk stratification.

FK506-Binding Protein 5 mRNA Levels in Ileal Mucosa Are Associated with Pouchitis in Patients with Ulcerative Colitis

“…Although the etiology of pouchitis remains unclear, several studies have reported an increased incidence of pouchitis in patients with extraintestinal manifestations [17][18][19][20][21], especially for primary sclerosing cholangitis [22][23][24], shorter disease duration [15], extent of disease [15,21], younger age [21], more severe preoperative clinical course [2], and steroid dependency [2]. Moreover, several medical therapies, such as steroid use before colectomy [18,21], postoperative use of nonsteroidal anti-inflammatory drugs [19], and preoperative and postoperative use of biologics [25], have significant associations with pouchitis. Postoperative complications, including anastomotic dehiscence [24,26] and stricture [27], are considered as causes of secondary pouchitis.…”

Colonic Histological Criteria Predict Development of Pouchitis after Ileal Pouch: Anal Anastomosis for Patients with Ulcerative Colitis

“…In our series, there were no significant predictive factors of pouchitis or chronic pouchitis among these clinical factors. Moreover, it has been indicated that steroid use before colectomy [8,23] and steroid dependency [21] are significantly associated with pouchitis. In addition to a steroid-refractory state, the preoperative use of anti-TNF-α [20] is a risk factor for the development of pouchitis.…”

“…Although the mechanism underlying the development pouchitis remains unclear, several studies have reported an increased incidence of pouchitis in patients with a shorter disease duration of UC [4], extent of colitis [4,8,20], younger age [8], and more severe preoperative clinical course of UC [21]. Additionally, it is considered that extraintestinal manifestations [8,[22][23][24][25], especially primary sclerosing cholangitis [26][27][28], are significant predictors of pouchitis development.…”

“…Additionally, it is considered that extraintestinal manifestations [8,[22][23][24][25], especially primary sclerosing cholangitis [26][27][28], are significant predictors of pouchitis development. In our series, there were no significant predictive factors of pouchitis or chronic pouchitis among these clinical factors.…”

“…Although the cause and mechanism of pouchitis are incompletely understood, the extent of colonic disease is reportedly a significant predictor of pouchitis [4,8,9]. One study showed that terminal ileal active and chronic inflammation as well as the severity of colonic disease are significantly predictive of pouchitis [9].…”