Predictive factors for development of chronic pouchitis after ileal pouch-anal anastomosis in ulcerative colitis.
BACKGROUND
No previous studies have examined predictive factors for chronic pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) with consideration of changes in pouchitis subtypes during follow-up. This study evaluated the independent predictive factors for chronic pouchitis.


METHODS
A total of 244 consecutive patients who underwent IPAA were enrolled. We assessed the possible associations between pouchitis and clinical factors using Cox proportional hazard regression.


RESULTS
231 patients met the inclusion criteria. 66 (28.5%) patients developed pouchitis. In 9 of 44 (20.4%) patients, antibiotic-responsive pouchitis at the first episode changed into chronic pouchitis after the occurrence of a subsequent episode. The median duration from occurrence of antibiotic-responsive pouchitis to alteration into chronic pouchitis was 502 (range 147-1,697) days. Overall pouchitis was finally classified into 35 acute pouchitis and 31 chronic pouchitis cases. Multivariate analysis revealed that a ≥ 7.5-g cumulative steroid dose before colectomy and a ≥ 500-mg monthly steroid dose just before colectomy were significant predictive factors for chronic pouchitis (p = 0.0001 and 0.0095, respectively).


CONCLUSIONS
Patients with UC and a higher cumulative steroid dose before colectomy or higher monthly steroid dose just before colectomy may have a predictive factor for developing chronic pouchitis.
Division of Reparative Medicine, Departments of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan.
Yoshiki
Y
Okita
Toshimitsu
T
Araki
Koji
K
Tanaka
Kiyoshi
K
Hashimoto
Satoru
S
Kondo
Mikio
M
Kawamura
Yuki
Y
Koike
Kohei
K
Otake
Hiroyuki
H
Fujikawa
Mikihiro
M
Inoue
Masaki
M
Ohi
Yasuhiro
Y
Inoue
Keiichi
K
Uchida
Yasuhiko
Y
Mohri
Masato
M
Kusunoki
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019449:Pouchitis / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult