Early Pouchitis Linked to Increased Risk for Antibiotic and CD-Like Pouch Conditions

Early pouchitis is associated with an increased risk for chronic antibiotic-dependent pouchitis (CADP) and Crohn disease-like disease of the pouch (CLDP), according to study results published in Digestive Diseases and Sciences.

Researchers sought to investigate a potential relationship between acute pouchitis within 180 days of the final stage of ileal pouch-anal anastomosis (IPAA) operation for ulcerative colitis (UC) and the subsequent development of CADP and CLDP.

All study participants had undergone restorative proctocolectomy with IPAA for UC. The patients were identified using the Carolina Data Warehouse for Health, a repository for electronic health records. The primary outcome was the development of CADP, defined as 4 or more episodes of pouchitis in 12 months or a need for continuous antibiotics to treat pouchitis.

Of 626 total patients enrolled in the study, 12% developed CADP in the follow-up timeframe. Patients who were diagnosed with very early pouchitis were significantly more likely to develop CADP when compared with patients without very early pouchitis (25% vs 8%; P <.001). After adjusting for the duration of UC before colectomy, concomitant primary sclerosing cholangitis, and age at surgery, patients with very early pouchitis experienced an increased odds ratio for CADP (adjusted odds ratio, 3.65; 95% CI, 2.19-6.10).

Study limitations include a potential for underreporting of pouchitis due to the single-center study design and the possibility of selection bias.

“[P]ouchitis within 6 months after IPAA creation for UC, [sic] was associated with a significantly increased likelihood of developing CADP and CLDP,” the study authors noted. “The identification of very early pouchitis as a unique risk factor for chronic inflammatory conditions of the pouch has important implications for gastroenterologists, surgeons, and patients, to guide discussions of expectations and risk stratification.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Gastroenterology Advisor