B0359 - Early Pouchitis Is Associated With an Increased Likelihood of Chronic Antibiotic Dependent Pouchits and Crohn’s-Like Disease of the Pouch

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Scott Esckilsen, MD

University of North Carolina at Chapel Hill
Chapel Hill, NC

Scott Esckilsen, MD, Hans Herfarth, MD, PhD, Edward Barnes, MD, MPH
University of North Carolina at Chapel Hill, Chapel Hill, NC

Introduction: Approximately 80% of patients will develop pouchitis at some point after an IPAA for ulcerative colitis (UC), with 17% of patients developing chronic antibiotic dependent pouchitis (CADP) and and 10% developing Crohn’s-like disease of the pouch. Few reliable risk factors for these chronic inflammatory conditions of the pouch have been identified. We aimed to investigate the relationship between early pouchitis, defined as acute pouchitis within the first 180 days of the final stage of IPAA surgery, and the future development of CADP and Crohn’s-like disease of the pouch.

Methods: We performed a retrospective cohort study, evaluating patients who underwent proctocolectomy with IPAA at our center between January 1, 2004 and December 31, 2016. Multivariable logistic regression was used to evaluate the relationship between early pouchitis and the development of CADP and Crohn’s-like disease of the pouch, adjusting for other relevant clinical and demographic factors.

Results: Among 626 patients undergoing IPAA for UC, 137 (22%) developed early pouchitis, 75 (12%) developed CADP, and 59 (9%) developed Crohn’s-like disease of the pouch. Patients developing early pouchitis were significantly more likely to be of Hispanic ethnicity compared to patients who did not develop early pouchitis (5.6% vs. 1.4%, p=0.006, Table 1). Early pouchitis was associated with a significant increase in the odds of developing CADP (adjusted odds ratio [aOR] 3.65, 95% CI 2.19-6.10). A preoperative diagnosis of PSC was also associated with an increase in the odds of developing CADP (aOR 3.97, 95% CI 1.44-11.0). Early pouchitis was also associated with an increased likelihood of developing Crohn’s-like disease of the pouch (aOR 2.68, 95% CI 1.50-4.80) as was a family history of inflammatory bowel disease (aOR 2.10, 95% CI 1.11-3.96). The median duration of follow up for all patients in the study was 5.18 years (interquartile range 0.94 – 10.8 years).

Discussion: In a cohort of patients with UC who underwent IPAA, the development of pouchitis within the first 180 days of surgery was associated with an increased risk of developing CADP and Crohn’s-like disease of the pouch. These findings highlight early pouchitis as a unique risk factor for chronic pouch-related disorders and the need for future studies evaluating potential interventions including secondary prophylaxis strategies in this population.

	Patients without early pouchitis (n=489)		Patients with early pouchitis (n=137)		p-value
	median	IQR	median	IQR
Age at surgery, in years	40.3	28.8-52.4	43.1	33.7-54.5	0.094
Disease duration prior to surgery	5.9	2.2-14.2	6.3	2.0-13.6	0.854
	n	%	n	%
Race					0.923
White	424	89.3	121	89.0
Non-White	51	10.7	15	11.0
Hispanic	6	1.4	7	5.6	0.006
Family history of Crohn's disease or ulcerative colitis	83	16.2	14	20.0	0.421
Indication for surgery					0.059
Medically-refractory colitis	376	76.9	118	86.1
Dysplasia or cancer	72	14.7	11	8.0
Other indications/multiple indications	41	8.4	8	5.8
Disease extent prior to surgery					0.405
Proctitis	23	5.0	3	2.3
Left-sided colitis	133	29.1	40	30.8
Extensive colitis	301	65.9	87	66.9
Stages involved in IPAA surgery					0.977
1	92	18.9	24	17.5
2	173	35.5	51	37.2
Modified 2	183	37.5	11	37.2
3	40	8.2	51	8.0
Abscess or pelvic sepsis after IPAA surgery	94	19.2	23	16.8	0.518
Evidence of an IPAA leak immediately after IPAA surgery	38	7.8	8	5.8	0.444
Primary Sclerosing Cholangitis	13	2.7	6	4.4	0.299
Medications used prior to colectomy
Systemic aminosalicylate	380	77.7	115	83.9	0.113
Topical aminosalicylate	230	47.0	72	52.6	0.253
Thiopurine	299	61.2	91	66.4	0.256
Methotrexate	58	11.9	9	6.6	0.077
Anti-TNF	252	51.5	69	50.4	0.809
Vedolizumab	11	2.3	6	4.4	0.175
Cyclosporine	13	2.7	13	9.5	< 0.001
Prednisone use at the time of last stage of surgery	192	39.3	58	42.7	0.487

Table: Table 1. Univariate comparison of demographic and clinical characteristics of patients with and without pouchitis in the two years following an ileal pouch-anal anastomosis

Disclosures:

Scott Esckilsen indicated no relevant financial relationships.

Hans Herfarth: Alivio – Consultant. Artizan – Grant/Research Support. BMS – Advisory Committee/Board Member. Boehringer – Advisory Committee/Board Member. ExeGi – Consultant. Finch – Consultant. Gilead – Consultant. Janssen – Consultant. NovoNordisk – Grant/Research Support. Pfizer – Grant/Research Support.

Edward Barnes: AbbVie, Inc. – Consultant. Gilead – Advisory Committee/Board Member. Lilly – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member. Target RWE – Consultant.

Scott Esckilsen, MD, Hans Herfarth, MD, PhD, Edward Barnes, MD, MPH. B0359 - Early Pouchitis Is Associated With an Increased Likelihood of Chronic Antibiotic Dependent Pouchits and Crohn’s-Like Disease of the Pouch, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.