title: Male Gender Is Associated with a High Risk for Chronic Antibiotic-Refractory Pouchitis and Ileal Pouch Anastomotic Sinus.
abstract: OBJECTIVE
  The impact of gender on the development of chronic ileal pouch disorders following ileal pouch-anal anastomosis (IPAA) has not been evaluated. This study was aimed to assess the association between gender and pouch outcomes.
  
  
  METHODS
  Comparisons of long-term pouch outcomes between male and female patients were performed using both univariate and multivariate analyses.
  
  
  RESULTS
  Of all patients enrolled (n = 1564), 881(56.3 %) were males. Male patients were older at the time of inflammatory bowel disease (IBD) diagnosis and pouch construction. The frequencies of neoplasia as the indication for colectomy and significant comorbidity were higher in males, while fewer male patients had IBD-related extra-intestinal manifestations or concurrent autoimmune disorders. There was no significant difference between the genders in other clinicopathological characteristics. More male patients (n = 144, 16.3 %) developed chronic antibiotic-refractory pouchitis (CARP) than females (n = 73, 10.7 %) (P = 0.001). Seventy-four males (8.4 %) had ileal pouch anastomotic sinus versus 22 female patients (3.2 %) (P < 0.001). Multivariate logistic regression analyses confirmed the association between male gender and CARP (odds ratio (OR) 1.64, 95 % confidence interval (CI) 1.21-2.24, P = 0.002) and male gender and ileal pouch anastomotic sinus (OR 2.85, 95 % CI 1.48-5.47, P = 0.002). After a median follow-up of 9.0 (interquartile range 4.0-14.0) years, pouch failed in a total of 126 patients (8.1 %). No significant difference was identified between male and female patients in pouch failure (P = 0.61).
  
  
  CONCLUSIONS
  Among the pouch patients referred to our subspecialty Pouch Center, male patients were found to have an increased risk for the CARP and ileal pouch sinus. The pathogenic mechanisms of the association warrant further study.
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Xian-Rui
authors.initials: XR
authors.lastname: Wu
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Ashburn
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Hagar
authors.initials: H
authors.lastname: Fass
authors.affiliation: Department of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA. shenb@ccf.org.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents; D002908:Chronic Disease; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019449:Pouchitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Anastomotic sinus; Ileal pouch-anal anastomosis; Pouchitis; Restorative proctocolectomy; Ulcerative colitis