title: Risk factors for diseases of ileal pouch-anal anastomosis after restorative proctocolectomy for ulcerative colitis.
abstract: OBJECTIVE
  Although pouchitis is considered the most common adverse sequela of ileal pouch-anal anastomosis (IPAA), inflammatory and noninflammatory conditions other than pouchitis are increasingly being recognized. The risk factors for these non-pouchitis conditions, including Crohn's disease (CD) of the pouch, cuffitis, and irritable pouch syndrome (IPS), have not been studied. The aim of this study was to assess risk factors for inflammatory and noninflammatory diseases of IPAA in a tertiary care setting.
  
  
  METHODS
  The study consisted of 240 consecutive patients who were classified as having healthy pouches (N = 49), pouchitis (N = 61), CD of the pouch (N = 39), cuffitis (N = 41), or IPS (N =50). Demographic and clinical features were assessed to determine risk factors for each of these conditions by using logistic regression analysis.
  
  
  RESULTS
  Risk factors remaining in the final logistic regression models were for pouchitis: IPAA indication for dysplasia (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.69-8.98), never having smoked (OR, 5.09; 95% CI, 1.01-25.69), no use of anti-anxiety agents (OR, 5.19; 95% CI, 1.45-18.59), or use of NSAIDs (OR, 3.24; 95% CI, 1.71-6.13); for CD of the pouch: a long duration of IPAA (OR, 1.20; 95% CI, 1.12-1.30) and current smoking (OR, 4.77; 95% CI, 1.39-16.25); for cuffitis: arthralgias (OR, 4.13; 95% CI, 1.91-8.94) and younger age (OR, 1.16; 95% CI, 1.01-1.33); and for IPS: use of antidepressants (OR, 4.17, 95% CI, 1.95-8.92) or anti-anxiety agents (OR, 3.21; 95% CI, 1.34-7.47).
  
  
  CONCLUSIONS
  The majority of risk factors for the 4 inflammatory and noninflammatory conditions of IPAA are different, suggesting that each of these diseases has a different etiology and pathogenesis. The identification and modification of these risk factors might help patients and clinicians to make a preoperative decision for IPAA, reduce IPAA-related morbidity, and improve response to treatment.
authors.affiliation: Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. shenb@ccf.org
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Aaron
authors.initials: A
authors.lastname: Brzezinski
authors.forename: Ana E
authors.initials: AE
authors.lastname: Bennett
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hammel
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Achkar
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bevins
authors.forename: Ian C
authors.initials: IC
authors.lastname: Lavery
authors.forename: Scott A
authors.initials: SA
authors.lastname: Strong
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.forename: Wendy
authors.initials: W
authors.lastname: Liu
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Bambrick
authors.forename: Kerry K
authors.initials: KK
authors.lastname: Sherman
authors.forename: Bret A
authors.initials: BA
authors.lastname: Lashner
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D003093:Colitis, Ulcerative / Q000601:surgery; D039021:Colonic Pouches / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D019449:Pouchitis / Q000145:classification / Q000453:epidemiology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012307:Risk Factors; D012907:Smoking
chemical_list: D014151:Anti-Anxiety Agents; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents