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Risk Factors and Quality of Life in Patients with Diffuse Pouchitis After Ileal Pouch Anal Anastomosis According to the Chicago Classification for J Pouch: a Retrospective Multicenter Cohort Study in China

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Pouchitis is a common late complication in patients with ulcerative colitis (UC) who undergo ileal pouch–anal anastomosis (IPAA). The heterogeneous nature of the clinical and endoscopic presentations could affect the evaluation of therapeutic interventions for pouchitis. Thus, identifying the risk factors and clinical outcomes of pouch inflammation at different sites and severity is becoming increasingly important for colorectal surgeons.

Methods

Data on patients who underwent IPAA January from 2008 to June 2022 in our three pouch centers affiliated with the China UC Pouch Center Union were retrospectively collected. Pouchitis was categorized as a different phenotype according to the Chicago Classification. J pouches were classified into short (14 ± 2 cm) and long pouches (22 ± 2 cm) according to the distribution of ileal pouch length in our institute.

Results

Altogether, 143 patients with a median follow-up time of 5.0 years (interquartile range: 2.0–8.0) were enrolled. Among them, 41 patients (28.7%) developed pouchitis and 32 patients (78%) had diffuse inflammation of the pouch. Patients with diffuse pouchitis had a higher pouchitis disease activity index and more seriously impaired improvement of long-term quality of life than those with pouch phenotypes. A short J pouch, recurrent UC, and preoperative high white blood cell count were independent risk factors for diffuse pouchitis. Furthermore, a short J pouch could effectively predict the occurrence of diffuse pouchitis with an area under the receiver-operating characteristic curve of 0.614, a sensitivity of 62.5%, and a specificity of 60.4% (p = 0.049) and significantly decreased the overall diffuse pouchitis-free survival compared to a long J pouch (p = 0.0002).

Conclusion

Diffuse pouchitis is a common phenotype of pouchitis that seriously impairs long-term prognosis. For colorectal surgeons, decision-making regarding pouch construction with an appropriate length should be considered to prevent the development of diffuse pouchitis.

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Data Availability

The data supporting the conclusions of this article will be made available by the authors.

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Funding

This work was supported by the National Natural Science Foundation of China (No. 82000481, 82270549, and 81873547), the Shanghai Sailing Program (No. 20YF1429400) and the Qingfeng Scientific Research Fund of the China Crohn’s & Colitis Foundation (CCCF) (No. CCCF-QF-2022C14-21).

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Author notes

  1. Weimin Xu, Yaosheng Wang, and Zhebin Hua contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 200092, Shanghai, China

    Weimin Xu, Yaosheng Wang, Zhebin Hua, Long Cui & Peng Du

  2. Department of Colorectal and Anal Surgery, Hubei Key Laboratory of Intestinal and Colorectal Diseases, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China

    Hang Hu, Wenhao Chen & Zhao Ding

  3. Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, China

    Zerong Cai, Xiaojian Wu & Lei Lian

  4. China UC Pouch Center Union, Shanghai, China

    Weimin Xu, Yaosheng Wang, Zhebin Hua, Hang Hu, Wenhao Chen, Zerong Cai, Long Cui, Xiaojian Wu, Lei Lian, Zhao Ding & Peng Du

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  1. Weimin Xu
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Contributions

Peng Du and Zhao Ding conceived the study. Weimin Xu analyzed the data and wrote the manuscript. Yaosheng Wang and Zhebin Hua assisted some analysis. Hang Hu, Wenhao Chen, and Zerong Cai collaborated to collect the information of patients. Long Cui, Xiaojian Wu, and Lei Lian reviewed and revised the manuscript. All authors approved the final version.

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Correspondence to Zhao Ding or Peng Du.

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Xu, W., Wang, Y., Hua, Z. et al. Risk Factors and Quality of Life in Patients with Diffuse Pouchitis After Ileal Pouch Anal Anastomosis According to the Chicago Classification for J Pouch: a Retrospective Multicenter Cohort Study in China. J Gastrointest Surg 27, 766–776 (2023). https://doi.org/10.1007/s11605-022-05563-y

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