title: Association between immune-associated disorders and adverse outcomes of ileal pouch-anal anastomosis.
abstract: OBJECTIVE
  Autoimmune disorders (ADs) frequently coexist with inflammatory bowel disease. The aim of the study was to determine whether coexisting AD in patients with ileal pouches increases the risk for chronic antibiotic-refractory pouchitis (CARP) and other inflammatory conditions of the pouch.
  
  
  METHODS
  A total of 622 patients seen in our Pouchitis Clinic were enrolled. We compared the prevalence of adverse outcomes of the pouch (including CARP, Crohn's disease of the pouch, and pouch failure) in patients with or without concurrent AD and assessed the factors for these adverse outcomes.
  
  
  RESULTS
  There were seven pouch disease categories: normal (N=60), irritable pouch syndrome (N=112), active pouchitis (N=131), CARP (N=67), Crohn's disease (N=131), cuffitis (N=83), surgical complications (N=36), and anismus (N=2). The prevalence of AD in these pouch disease categories was 4.5%, 12.5%, 9.2%, 13.4%, 10.7%, 3.8%, 1.5%, and 0%, respectively. The presence of at least one AD at time of pouch surgery was shown to be associated with a twofold increase in the risk for CARP (hazard ratio=2.29; 95% CI: 1.52, 3.46; P<0.001) and for pouch-associated hospitalization (hazard ratio=2.39; 95% CI: 1.59, 3.58; P<0.001). The presence of AD was not associated with increased risk for irritable pouch syndrome, active pouchitis, Crohn's disease, cuffitis, surgical complications, or pouch failure. Patients with Crohn's disease of the pouch had a 2.42 times higher risk for pouch failure (P=0.042) than these without. Active smoking or a history of smoking was shown to be associated with an increased risk for pouch-associated hospitalization and pouch failure.
  
  
  CONCLUSIONS
  AD appears to be associated with an increased risk for CARP, and the presence of the association between these AD and pouch disorders may stimulate further research on the link of these organ systems on an immunological basis.
authors.affiliation: Pouchitis Clinic, Digestive Disease Institute, Cleveland Clinic, Ohio 44195, USA. shenb@ccf.org
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nutter
authors.forename: Ana E
authors.initials: AE
authors.lastname: Bennett
authors.forename: Bret A
authors.initials: BA
authors.lastname: Lashner
authors.forename: Ian C
authors.initials: IC
authors.lastname: Lavery
authors.forename: Aaron
authors.initials: A
authors.lastname: Brzezinski
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Bambrick
authors.forename: Elaine
authors.initials: E
authors.lastname: Queener
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications*; D039021:Colonic Pouches / Q000009:adverse effects* / Q000276:immunology; D003424:Crohn Disease / Q000276:immunology* / Q000601:surgery; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000188:drug therapy / Q000276:immunology* / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation