Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis.

Abstract

Primary sclerosing cholangitis (PSC), present in 5% of patients with ulcerative colitis, may be associated with pouchitis after ileal pouch-anal anastomosis. The cumulative frequency of pouchitis in patients with and without PSC who underwent ileal pouch-anal anastomosis for ulcerative colitis was determined. A total of 1097 patients who had an ileal pouch-anal anastomosis for ulcerative colitis, 54 with associated PSC, were studied. Pouchitis was defined by clinical criteria in all patients and by clinical, endoscopic, and histological criteria in 83% of PSC patients and 85% of their matched controls. PSC was defined by clinical, radiological, and pathological findings. One or more episodes of pouchitis occurred in 32% of patients without PSC and 63% of patients with PSC. The cumulative risk of pouchitis at one, two, five, and 10 years after ileal pouch-anal anastomosis was 15.5%0 22/5%, 36%/ and 45.5% for the patients without PSC and 22%/ 43%, 61%, and 79% for the patients with PSC. In the PSC group, the risk of pouchitis was not related to the severity of liver disease. In conclusion, the strong correlation between PSC and pouchitis suggest a common link in their pathogenesis.

Both Preoperative Perinuclear Antineutrophil Cytoplasmic Antibody and Anti-CBir1 Expression in Ulcerative Colitis Patients Influence Pouchitis Development After Ileal Pouch–Anal Anastomosis

“…UC patients with EIMs, in particular primary sclerosing cholangitis, are clearly at risk for pouchitis after surgery (22)(23)(24). Some studies (25,26), but not all (27,28), suggest that patients with IC are also at a higher risk for pouchitis.…”

Faecal matrix metalloprotease-9 is a more sensitive marker for diagnosing pouchitis than faecal calprotectin: results from a pilot study

“…The incidence of pouchitis was 94% in patients who were followed for more than 6 years [3]. However, according to other studies, the reported cumulative frequency of pouchitis 10-11 years after IPAA surgery ranges from 23 to 46% [2,4,5]. Suzuki et al found the cumulative risk of pouchitis to be 10.7% at 1 year, 17.2% at 2 years, 24.0% at 5 years and 38.2% at 10 years [6].…”

A model of the long‐term cost effectiveness of scheduled maintenance treatment with infliximab for moderate‐to‐severe ulcerative colitis

“…Therefore, the first cycle was 8 weeks (weeks 0-8) followed by a 6-week cycle (weeks [8][9][10][11][12][13][14]. The cycle length thereafter was 8 weeks.…”

“…Transition probabilities for surgery and postsurgical states were obtained from the published literature. 9, 10 The probability of surgery was obtained from a European prospective inception cohort of UC patients. 10 The study estimated a 10-year cumulative colectomy rate of 8.7%, which was used for both the IFX and standard care treatment arms.…”

“…11 The long-term complication rate was derived from a study by Penna et al The authors estimated rates of 9% for pouch failures and 36% for pouchitis at 10 and 5 years respectively. 9 The risk of mortality was applied to patients in all health states such that patients could transition to the death from any state at any time. No additional UC related mortality was assumed and the risk of death was estimated using the risk of mortality of general population in England and Wales.…”