Primary sclerosing cholangitis and extraintestinal manifestations in patients with ulcerative colitis and ileal pouch-anal anastomosis.
OBJECTIVE
The aim of this study was to assess complications and functional outcomes in patients having ileal pouch-anal anastomosis for ulcerative colitis with or without primary sclerosing cholangitis or extraintestinal manifestations and to assess if primary sclerosing cholangitis is a risk factor for pouchitis.


METHODS
From 1984 to 2007, 289 patients underwent proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Mean follow-up time was 12 years and data was recorded prospectively. Eleven patients had primary sclerosing cholangitis, six had pyoderma gangrenosum, and 12 had arthritis or ankylosing spondylitis.


RESULTS
Early complications were similar for patients with or without extraintestinal manifestations. Functional outcomes were similar, but more incontinence among patients with sclerosing cholangitis was found. These patients had more frequent pouchitis, 5.25 vs. 2.72 average episodes of pouchitis (p = 0.048), and more chronic pouchitis, 4/11 vs. 17/260 (p < 0.001) compared to patients without adjunct disease. Neoplasm of the colon was more frequent in patients with primary sclerosing cholangitis, 4/11 vs. 4/260 in ulcerative colitis patients (p < 0.001).


CONCLUSIONS
An association between primary sclerosing cholangitis and chronic/severe pouchitis was found, but not with other extraintestinal manifestations. Functional results were good and alike in patients with and without primary sclerosing cholangitis. Primary sclerosing cholangitis is a risk factor for chronic pouchitis and is associated with neoplasia.
Wasmuth
Hans H
HH
Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. Hans.wasmuth@stolav.no
Tranø
Gerd
G
Endreseth
Birger H
BH
Wibe
Arne
A
Rydning
Astrid
A
Myrvold
Helge E
HE
D000328:Adult; D001168:Arthritis / Q000209:etiology; D015209:Cholangitis, Sclerosing / Q000150:complications*; D003093:Colitis, Ulcerative / Q000601:surgery*; D003110:Colonic Neoplasms / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D019449:Pouchitis / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D017511:Pyoderma Gangrenosum / Q000209:etiology*; D012308:Risk Management; D013167:Spondylitis, Ankylosing / Q000209:etiology; D016896:Treatment Outcome