4.4 Article

Ileal Pouch Anal Anastomosis (IPAA) for colitis; development of Crohn's and Pouchitis

Journal

AMERICAN JOURNAL OF SURGERY
Volume 224, Issue 1, Pages 453-458

Publisher

EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjsurg.2022.01.018

Keywords

Proctocolectomy; Restorative; Crohn's disease; Colitis; Ulcerative; Pouchitis

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The study found that the risk of Crohn's disease and chronic pouchitis is higher in patients undergoing IPAA surgery for ulcerative colitis, significantly increasing the likelihood of pouch failure.
Background: Chronic pouchitis and Crohn's disease after Ileal pouch anal anastomosis (IPAA) for ulcerative colitis could be a larger issue than previously reported. Methods: All patients receiving care for their IPAA over a 10-year period at a community hospital were included. Primary outcomes were incidence of Crohn's disease and pouchitis. Results: The study included 380 IPAA patients. Indication for pouch creation was either UC (n = 362) or indeterminate colitis (n = 18). Cumulative incidence of Crohn's was 19.5%. Five-, 10- and 20-year incidence of Cmhn's was 3.4%, 8.4% and 16.9%. Chronic pouchitis occurred in 28.7%. Mean time to pouchitis and Crohn's diagnosis was 8.4 (SD +/- 8.0) and 11.6 (SD +/- 7.5) years. Pouch failure occurred in 12.4%. Patients who developed Cmhn's were more likely to suffer pouchitis and pouch failure (OR 3.5, 95%CI 2.0-6.0 and 5.3, 95%CI 2.8-10.1). Conclusion: During long term follow up, almost 20% are diagnosed with Cmhn's contributing significantly to pouch failure.

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