Chronic pouchitis and Crohn's disease of the pouch after ileal pouch-anal anastomosis: Incidence and risk factors.
Colectomy
Crohn's disease
Ileal-pouch-anal anastomosis
Pouchitis
Ulcerative colitis
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
24
01
2021
revised:
07
03
2021
accepted:
24
03
2021
pubmed:
2
5
2021
medline:
4
2
2022
entrez:
1
5
2021
Statut:
ppublish
Résumé
Restorative proctocolectomy with ileal-pouch anal-anastomosis (IPAA) is the operation of choice for patients with ulcerative colitis (UC) or with inflammatory bowel diseases unclassified (IBDU). to assess the incidence and risk factors of chronic pouchitis (CP) and Crohn's disease of the pouch (CDP) in patients with UC or IBDU. We conducted a retrospective study. We included consecutive patients who underwent IPAA between 2011 and 2019. The main outcome was the occurrence of CP or CDP. We looked for risk factors with multivariable and a least absolute shrinkage and selection operator (LASSO) Cox models. 247 patients were included. The 5-year cumulative incidence of CP or CDP was 35.3% (95%CI: 26.2-43.2). In multivariable analysis, diagnosis of IBDU, age less than 35 years at surgery and extra-intestinal manifestations other than articular and primary sclerosing cholangitis were associated with higher incidence. The LASSO analysis identified these three prognostic factors and articular manifestations. In patients with two or more prognostic factors, 5-year cumulative incidence, was 65.2% (95%CI: 41.8-79.2). Five years after IPAA, approximately one-third of patients had either CP or CDP. Risk factors were IBDU, an age less than 35 years at surgery, articular manifestations and other extra-intestinal manifestations.
Sections du résumé
BACKGROUND
BACKGROUND
Restorative proctocolectomy with ileal-pouch anal-anastomosis (IPAA) is the operation of choice for patients with ulcerative colitis (UC) or with inflammatory bowel diseases unclassified (IBDU).
AIMS
OBJECTIVE
to assess the incidence and risk factors of chronic pouchitis (CP) and Crohn's disease of the pouch (CDP) in patients with UC or IBDU.
METHODS
METHODS
We conducted a retrospective study. We included consecutive patients who underwent IPAA between 2011 and 2019. The main outcome was the occurrence of CP or CDP. We looked for risk factors with multivariable and a least absolute shrinkage and selection operator (LASSO) Cox models.
RESULTS
RESULTS
247 patients were included. The 5-year cumulative incidence of CP or CDP was 35.3% (95%CI: 26.2-43.2). In multivariable analysis, diagnosis of IBDU, age less than 35 years at surgery and extra-intestinal manifestations other than articular and primary sclerosing cholangitis were associated with higher incidence. The LASSO analysis identified these three prognostic factors and articular manifestations. In patients with two or more prognostic factors, 5-year cumulative incidence, was 65.2% (95%CI: 41.8-79.2).
CONCLUSIONS
CONCLUSIONS
Five years after IPAA, approximately one-third of patients had either CP or CDP. Risk factors were IBDU, an age less than 35 years at surgery, articular manifestations and other extra-intestinal manifestations.
Identifiants
pubmed: 33931341
pii: S1590-8658(21)00143-2
doi: 10.1016/j.dld.2021.03.027
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1128-1135Informations de copyright
Copyright © 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interests CB, JK, NA, YP and AM declare no competing interest. AA received honoraria from Abbvie, Hospira, Takeda, Gilead, Biocodex, Janssen, Tillotts, Ferring, Pfizer and MSD. JHL received honoraria from Takeda. YB received honoraria from Abbvie, Biogaran, Boehringer Ingelheim, Celgene, Ferring, Gilead, Hospira, Janssen, Mayoly-Spindler, MSD, Norgine, Pfizer, Roche, Samsung Bioepis, Sandoz, Sanofi, Shire, Takeda, UCB. LB received honoraria from Janssen, Pfizer, Allergan, AbbVie, Janssen, MSD, Ferring Pharmaceuticals, Mayoly-Spindler, Takeda and Tillotts, and research support from Abbott, Ferring Pharmaceuticals, Hospira-Pfizer, Janssen, MSD, Takeda and Tillotts. MA received honoraria from Abbvie, MSD, Janssen, Takeda, Pfizer, Novartis, Ferring, Tillotts, Celgene and Genentech/Roche. AB received speaker fees from Takeda, Merck-Serono, Abbvie, Roche, Amgen and Janssen-Cilag and invitation to scientific meeting from Biom'up, Roche, Win'up surgical system and Intuitive surgical. FC received honoraria from Amgen, Arena, BMS, Celltrion, Enterome, Ferring, Janssen, Medtronic, Pfizer, Pharmacosmos, Roche, Takeda and Tillotts as well as lecture fees from Abbvie, Astra, Biogen, BMS, Ferring, Janssen, MSD, Pfizer, Pileje, Takeda and Tillotts.