E0374 - Iron Deficiency Is Common After Total Proctocolectomy With Ileal Pouch Anal Anastomosis in Patients With Ulcerative Colitis

Ishaan Dharia, MD¹, Taqwa Ahmed, MD¹, Michael Plietz, MD², Sergey Khaitov, MD¹, Patricia Sylla, MD¹, Alexander J. Greenstein, MD, MPH³, Marla C. Dubinsky, MD⁴, Maia Kayal, MD, MS^1
1Icahn School of Medicine at Mount Sinai, New York, NY; ²Icahn School of Medicine at Mount Sinai, Waltham, MA; ³Mount Sinai Hospital, New York, NY; ⁴Susan and Leonard Feinstein IBD Center, Icahn School of Medicine, Mount Sinai, New York, NY

Introduction: Approximately 10-15% of patients with ulcerative colitis (UC) complicated by medically refractory disease or dysplasia will require surgery, the most common of which is the staged total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA). Micronutrient deficiencies may occur after TPC with IPAA due to malabsorption in the setting of pouch inflammation. The aim of this study was to report the incidence of iron deficiency anemia in patients with UC who underwent TPC with IPAA and identify associated risk factors.

Methods: We conducted a retrospective chart review at a single, tertiary-care IBD center. Patients with UC or IBD unclassified (IBDU) who underwent TPC with IPAA at Mount Sinai Hospital between 1/ 2008 and 12/2017 were identified. Descriptive statistics were used to analyze the baseline characteristics and labs of the study population. Medians with interquartile range [IQR] were reported for continuous variables and proportions were reported for categorical variables. Iron deficiency was defined by ferritin < 30 ng/mL. Univariable logistic regression was used to analyze unadjusted relationships between hypothesized risk factors and outcomes.

Results: A total of 143 patients underwent iron studies a median of 3.0 [IQR 1.7-5.6] years after final surgical stage. Of these, 73 were men and the median age was 33.5 [IQR 22.7-44.3] years. The pouch-anal anastomosis was stapled in 100 (69.9%) patients and handsewn in 43 (30.1%). The median rectal cuff length was 1.5 cm [1-2].

The following median values were noted in the 143 patients: hemoglobin 13.2 g/dL [12.0-14.3], mean corpuscular value 86 fl [81.6-90.5], iron 59.5 mcg/dL [34.0-84.0], ferritin 39 ng/mL [17.0-79.5]. Iron deficiency was diagnosed in 80 (55.9%) patients with a median hemoglobin of 12.4 g/dL [10.9-13.3], ferritin of 14 ng/mL [9.0-23.3], and iron of 44 mcg/dL [26.0-68.8]. Of these, 29 (36.3%) had a pouchoscopy performed within three months of iron deficiency diagnosis. Pouchitis and cuffitis were separately noted in 4 (13.8%) and 13 (44.8%) patients, respectively, and concomitant pouchitis-cuffitis was noted in 9 (31.0%) patients.

Age, sex, anastomosis type, pouch duration, and history of pouchitis and/or cuffitis were not predictive of iron deficiency.

Discussion: Iron deficiency is common after TPC with IPAA in patients with UC. Cuffitis is seen in the majority of patients with iron deficiency.


Disclosures:


Ishaan Dharia, MD¹, Taqwa Ahmed, MD¹, Michael Plietz, MD², Sergey Khaitov, MD¹, Patricia Sylla, MD¹, Alexander J. Greenstein, MD, MPH³, Marla C. Dubinsky, MD⁴, Maia Kayal, MD, MS¹. E0374 - Iron Deficiency Is Common After Total Proctocolectomy With Ileal Pouch Anal Anastomosis in Patients With Ulcerative Colitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.