Risk factors for diseases of ileal pouch-anal anastomosis after restorative proctocolectomy for ulcerative colitis.
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.
Shen
Bo
B
Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. shenb@ccf.org
Fazio
Victor W
VW
Remzi
Feza H
FH
Brzezinski
Aaron
A
Bennett
Ana E
AE
Lopez
Rocio
R
Hammel
Jeffrey P
JP
Achkar
Jean-Paul
JP
Bevins
Charles L
CL
Lavery
Ian C
IC
Strong
Scott A
SA
Delaney
Conor P
CP
Liu
Wendy
W
Bambrick
Marlene L
ML
Sherman
Kerry K
KK
Lashner
Bret A
BA
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
D014151:Anti-Anxiety Agents; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents