The Cumulative Incidence of Pouchitis in Pediatric Patients With Ulcerative Colitis

• Published in: Inflammatory bowel diseases 2022-09, Vol.28 (9), p.1332-1337
• Main Authors: Cowherd, Ellen, Egberg, Matthew D, Kappelman, Michael D, Zhang, Xian, Long, Millie D, Lightner, Amy L, Sandler, Robert S, Herfarth, Hans H, Barnes, Edward L
• Format: Article
• Language: English
• Subjects: Child; Clinical Research; Colitis, Ulcerative - complications; Colonic Pouches; Humans; Incidence; Pouchitis - epidemiology; Pouchitis - etiology; Proctocolectomy, Restorative - adverse effects; Retrospective Studies
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1093/ibd/izab320

Abstract Background Despite highly effective therapies, many children develop medically refractory ulcerative colitis (UC) and undergo proctocolectomy with ileal pouch–anal anastomosis (IPAA). We sought to determine the incidence, risk, and burden of pouchitis in the first 2 years following the final stage of IPAA in pediatric UC patients. Methods Within the IQVIA Legacy PharMetrics Adjudicated Claims Database, we identified pediatric patients with UC who underwent proctocolectomy with IPAA between January 1, 2007, and June 30, 2015. We utilized International Classification of Diseases–Ninth Revision–Clinical Modification or International Classification of Diseases–Tenth Revision–Clinical Modification codes to identify patients with UC and Current Procedural Terminology codes to identify colectomy and IPAA. Continuous variables were compared using t tests and Wilcoxon rank sum testing, while categorical variables were compared using chi-square testing. Results A total of 68 patients with an IPAA were identified. In the first 2 years following IPAA, the cumulative incidence of pouchitis was 54%. Patients with pouchitis required more outpatient visits in the first 2 years after IPAA (mean 21.8 vs 10.2; P = .006) and were more likely to be hospitalized compared with patients without pouchitis (46% vs 23%; P = .045). Patients with pouchitis also demonstrated higher mean total costs in year 1 and year 2 ($27 489 vs $8032 [P = .001] and $27 699 vs $6058 [P = .003], respectively). Conclusions Our findings confirm the high incidence of pouchitis demonstrated in earlier single-center studies of pediatric patients undergoing proctocolectomy with IPAA for UC. Identification of risk factors for pouchitis would be useful to optimize early intervention. Lay Summary Among a geographically diverse patient population from the United States, we demonstrated that over half of pediatric patients undergoing proctocolectomy with ileal pouch–anal anastomosis for ulcerative colitis will develop pouchitis in the first 2 years after surgery.