Family history of Crohn's disease is associated with an increased risk for Crohn's disease of the pouch.
BACKGROUND
Crohn's disease (CD) of the pouch can occur in patients with restorative proctocolectomy and ileal pouch-anal anastomosis originally performed for a preoperative diagnosis of ulcerative colitis (UC). CD of the pouch was often observed in patients with a family history of CD. The purpose was to determine whether the family history of CD increased the risk for CD of the pouch in patients who underwent restorative proctocolectomy.


METHODS
A total of 558 eligible patients seen in the Pouchitis Clinic were enrolled, including 116 patients with CD of the pouch and 442 patients with a normal pouch or other pouch disorders. Demographic and clinical variables were included in the study. Multivariable logistic regression analyses were performed.


RESULTS
The adjusted multivariate logistic analyses revealed that the risk for CD of the pouch was increased in patients with a family history of CD, with an odds ratio (OR) of 3.22 (95% confidence interval [CI] 1.56-6.67), or with a first-degree relative with CD (OR = 4.18, 95% CI, 1.48-11.8), or with a greater number of family members with CD (OR = 2.00 per family member, 95% CI, 1.19-3.37), adjusting for age, gender, smoking status, duration of IBD, duration of having a pouch, and a preoperation diagnosis of indeterminate colitis or CD. In addition, patients of younger age and longer duration of having a pouch had a higher risk for CD of the pouch. A diagnosis of CD of the pouch was associated with a poor outcome, with a greater than 5-fold estimated increased odds of pouch failure (OR = 5.58, 95% CI, 2.74-11.4).


CONCLUSIONS
The presence of a family history of CD is associated with an increased risk for CD of the pouch, which in turn has a high risk for pouch failure.
Shen
Bo
B
Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. shenb@ccf.org
Remzi
Feza H
FH
Hammel
Jeffrey P
JP
Lashner
Bret A
BA
Bevins
Charles L
CL
Lavery
Ian C
IC
Wehkamp
Jan
J
Fazio
Victor W
VW
D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000235:genetics* / Q000601:surgery; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000209:etiology* / Q000235:genetics; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012307:Risk Factors; D016896:Treatment Outcome
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