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

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.

Automated summary

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.