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Very Early Pouchitis Is Associated with an Increased Likelihood of Chronic Inflammatory Conditions of the Pouch

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Abstract

Introduction

Chronic inflammatory conditions of the pouch are common after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).

Aims

We aimed to investigate the relationship between acute pouchitis within 180 days of the final stage of IPAA surgery (very early pouchitis) and the future development of chronic antibiotic dependent pouchitis (CADP) and Crohn’s-like disease of the pouch (CLDP).

Methods

We performed a retrospective cohort study, evaluating patients who underwent proctocolectomy with IPAA between January 1, 2004 and December 31, 2016. Multivariable logistic regression was used to evaluate the relationship between very early pouchitis and the development of CADP and CLDP.

Results

Among 626 patients undergoing IPAA for UC, 137 (22%) developed very early pouchitis, 75 (12%) developed CADP, and 59 (9%) developed CLDP in a median follow-up of 5.18 years (interquartile range 0.94–10.8 years). Very early pouchitis was associated with a significant increase in the odds of developing CADP (adjusted odds ratio [aOR3.65, 95% CI 2.19–6.10) as was primary sclerosing cholangitis (aOR 3.97, 95% CI 1.44–11.0). Very early pouchitis was associated with increased odds for developing CLDP (aOR 2.77, 95% CI 1.54–4.98) along with a family history of inflammatory bowel disease (aOR 2.10, 95% CI 1.11–3.96).

Conclusion

In this cohort, very early pouchitis was associated with an increased risk of developing CADP and CLDP. These findings highlight very early pouchitis as a unique risk factor for chronic inflammatory conditions of the pouch and the need for future studies evaluating potential strategies for secondary prophylaxis strategies in this population.

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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. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Scott Esckilsen

  2. Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA

    Bharati Kochar

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

    Bharati Kochar

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

    Kimberly N. Weaver, Hans H. Herfarth & Edward L. Barnes

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

    Kimberly N. Weaver, Hans H. Herfarth & Edward L. Barnes

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

    Hans H. Herfarth & Edward L. Barnes

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  1. Scott Esckilsen
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  2. Bharati Kochar
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  4. Hans H. Herfarth
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  5. Edward L. Barnes
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Contributions

SE: study design, data collection, interpretation of the data, drafting the manuscript, revising the manuscript. BK, KNW, HHH: study design, data collection, interpretation of the data, revising the manuscript. ELB: study design, data collection, data analysis, interpretation of the data, drafting the manuscript, revising the manuscript.

Corresponding author

Correspondence to Edward L. Barnes.

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Competing Interest

Scott Esckilsen has no relevant disclosures. Bharati Kochar has served as a consultant for Pfizer. Kimberly N. Weaver has served as a consultant for AbbVie and BMS. Hans H. Herfarth has served as a consultant for Alivio, AMAG, Boehringer, BMS, ExeGi Pharma, Finch, Fresenius Kabi, Gilead, Janssen, Lycera, Merck, Otsuka, Pfizer, PureTech, Seres and research support from Allakos, Artizan Biosciences, Novo Nordisk and Pfizer. Edward L. Barnes has served as a consultant for AbbVie, Bristol-Meyers Squibb, Eli Lilly, and Target RWE.

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Esckilsen, S., Kochar, B., Weaver, K.N. et al. Very Early Pouchitis Is Associated with an Increased Likelihood of Chronic Inflammatory Conditions of the Pouch. Dig Dis Sci 68, 3139–3147 (2023). https://doi.org/10.1007/s10620-023-07947-9

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  • DOI: https://doi.org/10.1007/s10620-023-07947-9

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