P0530 - A Comparative Analysis of the Modified Pouchitis Disease Activity Index and the Endoscopic Phenotypes of the J Pouch in Patients With Inflammatory Bowel Disease
University of Chicago Medicine Inflammatory Bowel Disease Center Chicago, IL, United States
Shintaro Akiyama, MD, PhD1, Nathaniel A. Cohen, MBBCh1, Jacob E. Ollech, MD1, Cindy Traboulsi, MD1, Tina G. Rodriguez, BA1, Victoria Rai, BS1, Laura R. Glick, MD1, Yangtian Yi, BA1, Joseph Runde, DO1, Russell D. Cohen, MD1, Kinga B. Skowron, MD1, Roger D. Hurst, MD1, Konstantin Umanskiy, MD1, Benjamin D. Shogan, MD1, Neil H. Hyman, MD1, Michele A. Rubin, APRN, CNS-BC, CGRN1, Sushila R. Dalal, MD1, Atsushi Sakuraba, MD, PhD1, Joel Pekow, MD1, Eugene B. Chang, MD1, David T. Rubin, MD, FACG2 1University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL; 2University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
Introduction: The modified pouchitis disease activity index (mPDAI), based on clinical symptoms and endoscopic findings, is often used to diagnose pouchitis, however validated instruments to monitor pouchitis disease activity are lacking. Our group recently proposed the “Chicago classification of pouchitis” describing 7 main endoscopic phenotypes with differing outcomes. In this study, we compared mPDAIs among phenotypes in patients with inflammatory bowel disease (IBD).
Methods: This is a retrospective study of IBD patients with a J pouch who underwent pouchoscopies at _____ between June 1997 and December 2019. We reviewed all available reports of pouchoscopies after ileostomy takedown and classified the pouches into 7 main phenotypes: (a) normal, (b) afferent limb (AL) involvement, (c) inlet (IL) involvement, (d) diffuse, (e) focal inflammation of the pouch body, (f) cuffitis, and (g) pouch fistulas. Pouch fistulas included pouches with any type of fistulas noted ≥6 months from ileostomy takedown. Patients who had a scope showing a single phenotype were included. We assessed mPDAI based on endoscopic findings and clinical symptoms at the clinical visit closest to the date of scope. Kruskal-Wallis test was used to assess the overall difference in mPDAIs between phenotypes. The Steel-Dwass test was used to compare mPDAIs of all pairs of groups. P values < 0.05 were considered statistically significant.
Results: We identified 103 IBD patients. Median mPDAI was 0 (range 0-3.0) in patients with normal pouch. Among inflammatory phenotypes, the highest median mPDAI was 4.0 (range 1.0-7.0) in cuffitis, followed by 3.0 (range 2.0-6.0) in diffuse inflammation, 2.5 (range 1.0-7.0) in inlet involvement, 2.5 (range 2.0-5.0) in AL involvement, 2.0 (range 1.0-7.0) in focal inflammation, and 1.0 (range 0-4.0) in pouch fistulas (Figure 1). Kruskal-Wallis test showed that overall difference in mPDAIs between phenotypes was significant (P < 0.001). The Steel-Dwass test revealed that mPDAI in the normal pouch was significantly lower compared with pouches with IL involvement, diffuse inflammation, focal inflammation, or cuffitis (P < 0.05).
Discussion: We demonstrated that mPDAI was lowest in patients with a normal pouch and highest in those with cuffitis. Our findings suggest that low mPDAI scores may be associated with pouch normalization and that measures of disease activity for cuffitis should be distinct from those of other inflammatory pouch phenotypes.
Figure: Modified pouchitis disease activity index (mPDAI) among pouch phenotypes
Disclosures: Shintaro Akiyama indicated no relevant financial relationships. Nathaniel Cohen indicated no relevant financial relationships. Jacob Ollech indicated no relevant financial relationships. Cindy Traboulsi indicated no relevant financial relationships. Tina Rodriguez: Abbvie – Consultant. Allergan, Inc. – Consultant. Altrubio – Consultant. Arena Pharmaceuticals – Consultant. Athos Therapeutics – Consultant. Bellatrix Pharmaceuticals – Consultant. Boehringer Ingelheim, Ltd. – Consultant. Bristol-Myers Squibb – Consultant. Celgene Corp/Syneos – Consultant. Connect BioPharma – Consultant. GalenPharma/Atlantica – Consultant. Genentech/Roche – Consultant. Gilead Sciences – Consultant. InDex Pharmaceuticals – Consultant. Ironwood Pharmaceuticals – Consultant. Iterative Scopes – Consultant. Janssen Pharmaceuticals – Consultant. Lilly – Consultant. Materia Prima – Consultant. Pfizer – Consultant. Prometheus Biosciences – Consultant. Reistone – Consultant. Takeda – Consultant, Grant/Research Support. Techlab, Inc. – Consultant. Victoria Rai indicated no relevant financial relationships. Laura Glick indicated no relevant financial relationships. Yangtian Yi indicated no relevant financial relationships. Joseph Runde indicated no relevant financial relationships. Russell Cohen: Abbvie – Consultant, Speaker's Bureau. BMS Celgene – Consultant. Eli Lilly – Consultant. Genentech – Consultant. Gilead Sciences – Consultant. Hoffmann La-Roche – Consultant. Janssen – Consultant. Pfizer – Consultant. Takeda – Consultant, Speaker's Bureau. UCB Pharma – Consultant. Kinga Skowron indicated no relevant financial relationships. Roger Hurst indicated no relevant financial relationships. Konstantin Umanskiy: Cooper Surgical – Consultant. Covidien – Consultant. Benjamin Shogan indicated no relevant financial relationships. Neil Hyman indicated no relevant financial relationships. Michele Rubin indicated no relevant financial relationships. Sushila Dalal: Abbvie – Advisory Committee/Board Member, Speaker's Bureau. Pfizer – Advisory Committee/Board Member, Consultant. Atsushi Sakuraba indicated no relevant financial relationships. Joel Pekow: Abbvie – Grant/Research Support. CVS Caremark – Advisory Committee/Board Member. Genentech – Advisory Committee/Board Member. Takeda – Advisory Committee/Board Member, Grant/Research Support. Verasatem – Consultant. Eugene Chang indicated no relevant financial relationships. David Rubin: Abbvie – Consultant. Allergan, Inc. – Consultant. Altrubio – Consultant. Arena Pharmaceuticals – Consultant. Athos Therapeutics – Consultant. Bellatrix Pharmaceuticals – Consultant. Boehringer Ingelheim, Ltd. – Consultant. Bristol-Myers Squibb – Consultant. Celgene Corp/Syneos – Consultant. Connect BioPharma – Consultant. GalenPharma/Atlantica – Consultant. Genentech/Roche – Consultant. Gilead Sciences – Consultant. InDex Pharmaceuticals – Consultant. Ironwood Pharmaceuticals – Consultant. Iterative Scopes – Consultant. Janssen Pharmaceuticals – Consultant. Lilly – Consultant. Materia Prima – Consultant. Pfizer – Consultant. Prometheus Biosciences – Consultant. Reistone – Consultant. Takeda – Consultant, Grant/Research Support. Techlab, Inc. – Consultant.
Shintaro Akiyama, MD, PhD1, Nathaniel A. Cohen, MBBCh1, Jacob E. Ollech, MD1, Cindy Traboulsi, MD1, Tina G. Rodriguez, BA1, Victoria Rai, BS1, Laura R. Glick, MD1, Yangtian Yi, BA1, Joseph Runde, DO1, Russell D. Cohen, MD1, Kinga B. Skowron, MD1, Roger D. Hurst, MD1, Konstantin Umanskiy, MD1, Benjamin D. Shogan, MD1, Neil H. Hyman, MD1, Michele A. Rubin, APRN, CNS-BC, CGRN1, Sushila R. Dalal, MD1, Atsushi Sakuraba, MD, PhD1, Joel Pekow, MD1, Eugene B. Chang, MD1, David T. Rubin, MD, FACG2. P0530 - A Comparative Analysis of the Modified Pouchitis Disease Activity Index and the Endoscopic Phenotypes of the J Pouch in Patients With Inflammatory Bowel Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
