title: A prospective multivariate analysis of clinical factors associated with pouchitis after ileal pouch-anal anastomosis.
abstract: OBJECTIVE
  Although acute pouchitis (AP) after ileal pouch-anal anastomosis (IPAA) for UC is common and easily treated, chronic pouchitis (CP) remains a difficult management issue. The aim of this study was to identify important clinical risk factors associated with AP or CP.
  
  
  METHODS
  AP and CP were prospectively assessed, and demographic, disease, and treatment characteristics were tabulated. Univariate and multivariate analyses were performed to evaluate associations between AP or CP and potential risk factors.
  
  
  RESULTS
  Two hundred IPAA patients were followed for a median of 24 months (range, 3-117 months). Thirty-six patients (18%) developed AP, and 23 patients (12%) developed CP. On univariate analysis, the use of steroids before colectomy and smoking were associated with the development of AP. CP was associated with male gender, smoking, length of follow-up, extraintestinal manifestations, backwash ileitis, and elevated (450x10(9)/L) platelet count. On multivariate analysis, the following risk factors were found to be independently associated with AP: use of steroids before colectomy (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-8.9; P = .004) and smoking (OR, 2.3; 95% CI, 1.1-5.3; P = .04). CP was directly associated with extraintestinal manifestations (OR, 3.5; 95% CI, 1.1-11.1; P = .03), elevated platelet count (OR, 3.1; 95% CI, 1.1-8.9; P = .03), and increased length of follow-up (OR, 1.3; 95% CI, 1.1-1.6; P = .002). Smoking reduced the incidence of CP (OR, 0.2; 95% CI, 0.05-0.74; P = .04).
  
  
  CONCLUSIONS
  Clinical factors associated with AP included use of steroids before colectomy and smoking. Factors directly related to CP were extraintestinal manifestations, elevated platelet count, and length of follow-up after IPAA. Smoking appears to protect against the development of CP.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA. PFleshner@aol.com
authors.forename: Phillip
authors.initials: P
authors.lastname: Fleshner
authors.forename: Andrew
authors.initials: A
authors.lastname: Ippoliti
authors.forename: Marla
authors.initials: M
authors.lastname: Dubinsky
authors.forename: Steven
authors.initials: S
authors.lastname: Ognibene
authors.forename: Eric
authors.initials: E
authors.lastname: Vasiliauskas
authors.forename: Marjorie
authors.initials: M
authors.lastname: Chelly
authors.forename: Ling
authors.initials: L
authors.lastname: Mei
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Papadakis
authors.forename: Carol
authors.initials: C
authors.lastname: Landers
authors.forename: Stephan
authors.initials: S
authors.lastname: Targan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001706:Biopsy; D002648:Child; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D039021:Colonic Pouches; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D019449:Pouchitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*