Risk Factors and Postoperative Outcomes in Pouchitis Following Restorative Proctocolectomy: An 18-Year Single-Center Study

Bibliographic Details
Title:	Risk Factors and Postoperative Outcomes in Pouchitis Following Restorative Proctocolectomy: An 18-Year Single-Center Study
Authors:	Luisa Bertin, Mohamad Nasrallah, Carlo Redavid, Erica Bonazzi, Daria Maniero, Greta Lorenzon, Caterina De Barba, Sonia Facchin, Marco Scarpa, Cesare Ruffolo, Imerio Angriman, Andrea Buda, Matteo Fassan, Carmelo Lacognata, Brigida Barberio, Fabiana Zingone, Edoardo Vincenzo Savarino
Source:	Gastroenterology Insights, Vol 15, Iss 4, Pp 1075-1092 (2024)
Publisher Information:	MDPI AG, 2024.
Publication Year:	2024
Collection:	LCC:Diseases of the digestive system. Gastroenterology
Subject Terms:	inflammatory bowel disease, restorative proctocolectomy with ileo-anal pouch anastomosis, pouchitis, pouch failure, Pouchitis Disease Activity Index, biologic therapy, Diseases of the digestive system. Gastroenterology, RC799-869
More Details:	Background/Objectives: Restorative proctocolectomy with ileo-anal pouch anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC). However, complications like pouchitis can occur. This study aimed to describe patients who underwent IPAA for inflammatory bowel disease (IBD) at Padua Hospital from 2005 to 2023 and identify risk factors for pouchitis. Secondary objectives included evaluating the effectiveness of biological therapy in chronic antibiotic-refractory pouchitis (CARP), Crohn’s disease of the pouch (CDP), and Crohn’s-like inflammation of the pouch (CDLPI), and assessing risk factors for pouch failure. Methods: This retrospective, observational study included 109 patients whose data were collected from medical records. Univariate logistic regression was used to analyze associations between preoperative and postoperative factors and outcomes such as acute pouchitis and pouch failure. The effectiveness of biological therapy was assessed by measuring changes in the Pouchitis Disease Activity Index (PDAI) and the Modified Pouchitis Disease Activity Index (mPDAI) over a 12-month treatment period. Results: Univariate logistic regression revealed significant associations between preoperative extraintestinal manifestations (OR 3.569, 95% CI 1.240–10.720), previous diagnosis of Crohn’s disease (OR 10.675, 95% CI 1.265–90.089), and transmural inflammation at cross-sectional imaging before surgery (OR 3.453, 95% CI 1.193–9.991) with an acute pouchitis risk. Pouch failure was significantly associated with a previous diagnosis of Crohn’s disease (OR 9.500, 95% CI 1.821–49.571) and post-surgical fistulas (OR 41.597, 95% CI 4.022–430.172). Biological therapy led to a significant reduction in the PDAI score in patients with CARP, decreasing from a median of 10 to 4 (p = 0.006). Similarly, in patients with CDP or CDLPI, the mPDAI score was significantly reduced from a median of 9 to 1 (p = 0.034), with remission achieved in 5/6 (83.3%) of these patients. Conclusions: This study provides valuable insights into the management of IPAA patients and highlights the importance of early identification and treatment of risk factors for pouchitis and failure. Biological therapy demonstrated significant effectiveness in reducing disease activity in patients with CARP, CDP, and CDLPI, suggesting its role as a crucial component in managing these complications.
Document Type:	article
File Description:	electronic resource
Language:	English
ISSN:	2036-7422 2036-7414
Relation:	https://www.mdpi.com/2036-7422/15/4/74; https://doaj.org/toc/2036-7414; https://doaj.org/toc/2036-7422
DOI:	10.3390/gastroent15040074
Access URL:	https://doaj.org/article/d751e4d370bc4c298b8f6662a4758056
Accession Number:	edsdoj.751e4d370bc4c298b8f6662a4758056
Database:	Directory of Open Access Journals
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More Details
ISSN:	20367422 20367414
DOI:	10.3390/gastroent15040074
Published in:	Gastroenterology Insights
Language:	English