Extraintestinal Manifestations and Family History of Inflammatory Bowel Disease Increase the Risk of Pouchitis in a State-Level Epidemiology Study

• Published in: Clinical and translational gastroenterology 2024-02, Vol.15 (2), p.e00670
• Main Authors: Barnes, Edward L, Dunn, Michael S, Ashburn, Jean, Barto, Amy, Bloomfeld, Richard, Cairns, Ashley, Mehta, Kurren, Patel, Pooja, Dziwis, Jennifer, Esckilsen, Scott, Rahbar, Reza, Sadiq, Timothy S, Hanson, John S, Herfarth, Hans H
• Format: Article
• Language: English
• ISSN: 2155-384X; 2155-384X
• DOI: 10.14309/ctg.0000000000000670

Our understanding of the epidemiology of inflammatory conditions of the pouch and effectiveness of treatment is largely based on selected populations. We created a state-level registry to evaluate the incidence of pouchitis and the effectiveness of treatments utilized in an initial episode of pouchitis. In a state-level retrospective cohort of all patients undergoing proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) between January 1, 2018 and December 31, 2020, we evaluated the incidence of pouchitis and compared the proportion of patients developing recurrent pouchitis and chronic antibiotic dependent pouchitis (CADP) according to initial antibiotic therapy. A total of 177 patients underwent surgery with 49 (28%) developing pouchitis within the 12 months after the final stage of IPAA. Patients with extraintestinal manifestations of inflammatory bowel disease (IBD) were significantly more likely to develop pouchitis within the first 12 months after IPAA (adjusted odds ratio [aOR] 2.45, 95% CI 1.03-5.81) after adjusting for family history of IBD (aOR 3.50, 95% 1.50-8.18). When comparing the proportion of patients who developed recurrent pouchitis or CADP to those who experienced an isolated episode of pouchitis, there were no significant differences among the initial antibiotic regimens utilized. In a state-level examination of outcomes after IPAA for UC, patients with extraintestinal manifestations of IBD were more likely to develop pouchitis however the initial antibiotic regimen chosen did not appear to impact long-term outcomes.