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Relationship Between Stages of Ileal Pouch-Anal Anastomosis, Timing of Restoration of Fecal Continuity, and Pouchitis

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Abstract

Background

The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis.

Aims

We aimed to investigate whether a shorter period between pouch creation and restoration of fecal flow through an IPAA was associated with an increased risk of development of pouchitis within the first 2 years after IPAA.

Methods

We performed a retrospective cohort study evaluating patients undergoing colectomy with IPAA for UC between January 1, 2004 and December 31, 2016. We used Kaplan–Meier testing and Cox Proportional Hazards Modeling to evaluate the relationship between the time between restoration of fecal continuity and time to subsequent development of pouchitis, adjusting for other clinical and demographic factors.

Results

We identified 624 patients who underwent proctocolectomy with IPAA for UC, of whom 246 (39%) developed pouchitis within the first 2 years after IPAA. There was no difference when comparing the median time to restoration of continuity among those patients who developed pouchitis and those who did not (49 days vs. 49 days, p = 0.85) or in multivariable analysis. Primary sclerosing cholangitis (Hazard Ratio [HR] 2.14, 95% CI 1.12–4.08), family history of inflammatory bowel disease (HR 1.49, 95% CI 1.08–2.06), and delayed pouch creation (HR 0.75, 95% CI 0.57–1.00) were significantly associated with time to development of pouchitis.

Conclusion

Although a staged approach to IPAA may have benefits in the surgical management of UC, the timing interval between pouch creation and restoration of continuity did not impact the subsequent development of early pouchitis in this cohort.

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Funding

This research was supported by the National Institutes of Health [K23DK127157-01 (ELB)].

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Authors and Affiliations

  1. University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia St., Chapel Hill, NC, 27516, USA

    Gary C. Sherrill

  2. Department of Medicine, University of North Carolina at Chapel Hill, 126 Macnider Hall, Chapel Hill, NC, 27599, USA

    Scott Esckilsen

  3. Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Campus Box #7080, 130 Mason Farm Road, Chapel Hill, NC, 27599-7080, USA

    Joshua Hudson, Hans H. Herfarth & Edward L. Barnes

  4. Division of Gastroenterology, Massachusetts General Hospital, MGH Crohn’s & Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA, 02114, USA

    Bharati Kochar

  5. Clinical Translational Epidemiology Unit, The Mongan Institute, Boston, MA, USA

    Bharati Kochar

  6. Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Hans H. Herfarth & Edward L. Barnes

  7. Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Hans H. Herfarth & Edward L. Barnes

Authors
  1. Gary C. Sherrill
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  2. Scott Esckilsen
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  3. Joshua Hudson
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  4. Bharati Kochar
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  5. Hans H. Herfarth
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  6. Edward L. Barnes
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Corresponding author

Correspondence to Edward L. Barnes.

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Conflict of interest

ELB has served as a consultant for AbbVie, Pfizer, and Target RWE. BK has served as a consultant for Pfizer. HHH has served as a consultant for Alivio, AMAG, Finch, Gilead, Lycera, Merck, Otsuka, Pfizer, PureTech, Seres and research support from Pfizer and Artizan Biosciences. GCS, JH, and SE have no relevant disclosures.

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Sherrill, G.C., Esckilsen, S., Hudson, J. et al. Relationship Between Stages of Ileal Pouch-Anal Anastomosis, Timing of Restoration of Fecal Continuity, and Pouchitis. Dig Dis Sci 67, 5220–5226 (2022). https://doi.org/10.1007/s10620-022-07440-9

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  • DOI: https://doi.org/10.1007/s10620-022-07440-9

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