title: Risk factors for chronic pouchitis after ileal pouch-anal anastomosis: a prospective cohort study.
abstract: OBJECTIVE
  The association between various demographic, clinical and pathological parameters and the evolution of chronic pouchitis was evaluated.
  
  
  METHODS
  All ulcerative colitis patients who underwent ileal pouch anal anastomosis (1981-2009) were followed prospectively in a comprehensive pouch clinic. We examined risk factors including the presence of appendiceal inflammation and backwash ileitis in the colonic specimen, gender, ethnicity, age at disease onset, disease duration, extent of colitis, presence of extraintestinal manifestations (e.g. primary sclerosing cholangitis), family history of inflammatory bowel disease, indication for surgery, medical treatment, age at operation, staged procedure, diverting ileostomy and length of follow-up. Univariate analysis was performed on all risk factors followed by logistic regression analysis.
  
  
  RESULTS
  The 201 enrolled patients (106 women, age at surgery 35 ± 15 years) were followed for a mean of 108 months. One hundred and thirty-eight (69%) had either a normal pouch or episodes of acute pouchitis and 63 (31%) developed chronic pouchitis. On univariate analysis the presence of an ileostomy (P = 0.017), pancolitis (P = 0.008), shorter disease duration (P = 0.04) and longer follow-up (P = 0.01) were identified as risk factors for chronic pouchitis. Multivariate analysis showed that patients with pancolitis (OR 3.26, 95% CI 1.20-8.85) and longer follow-up (OR 1.09, 95% CI 1.01-1.18) were more likely to develop chronic pouchitis. There was also an association to disease duration but this did not reach a level of significance.
  
  
  CONCLUSIONS
  Pancolitis and longer follow-up are directly related to the development of chronic pouchitis.
authors.affiliation: Comprehensive Pouch Clinic IBD Center, Department of Gastroenterology and Liver Diseases Proctology Unit, Department of Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Hashavia
authors.forename: I
authors.initials: I
authors.lastname: Dotan
authors.forename: M
authors.initials: M
authors.lastname: Rabau
authors.forename: J M
authors.initials: JM
authors.lastname: Klausner
authors.forename: Z
authors.initials: Z
authors.lastname: Halpern
authors.forename: H
authors.initials: H
authors.lastname: Tulchinsky
mesh_terms: D000328:Adult; D017668:Age of Onset; D001003:Anal Canal / Q000601:surgery; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000379:methods; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D003106:Colon / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019449:Pouchitis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors