The Cumulative Incidence of Pouchitis in Pediatric Patients With Ulcerative Colitis.

Child Colitis, Ulcerative / complications Colonic Pouches Humans Incidence Pouchitis / epidemiology Proctocolectomy, Restorative / adverse effects Retrospective Studies
J-pouch administrative claims ileal pouch-anal anastomosis pouchitis

Journal

Inflammatory bowel diseases
ISSN: 1536-4844
Titre abrégé: Inflamm Bowel Dis
Pays: England
ID NLM: 9508162

Informations de publication

Date de publication:
01 09 2022
Historique:
received: 06 08 2021
pubmed: 19 1 2022
medline: 9 9 2022
entrez: 18 1 2022
Statut: ppublish

Résumé

Despite highly effective therapies, many children develop medically refractory ulcerative colitis (UC) and undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). We sought to determine the incidence, risk, and burden of pouchitis in the first 2 years following the final stage of IPAA in pediatric UC patients. Within the IQVIA Legacy PharMetrics Adjudicated Claims Database, we identified pediatric patients with UC who underwent proctocolectomy with IPAA between January 1, 2007, and June 30, 2015. We utilized International Classification of Diseases-Ninth Revision-Clinical Modification or International Classification of Diseases-Tenth Revision-Clinical Modification codes to identify patients with UC and Current Procedural Terminology codes to identify colectomy and IPAA. Continuous variables were compared using t tests and Wilcoxon rank sum testing, while categorical variables were compared using chi-square testing. A total of 68 patients with an IPAA were identified. In the first 2 years following IPAA, the cumulative incidence of pouchitis was 54%. Patients with pouchitis required more outpatient visits in the first 2 years after IPAA (mean 21.8 vs 10.2; P = .006) and were more likely to be hospitalized compared with patients without pouchitis (46% vs 23%; P = .045). Patients with pouchitis also demonstrated higher mean total costs in year 1 and year 2 ($27 489 vs $8032 [P = .001] and $27 699 vs $6058 [P = .003], respectively). Our findings confirm the high incidence of pouchitis demonstrated in earlier single-center studies of pediatric patients undergoing proctocolectomy with IPAA for UC. Identification of risk factors for pouchitis would be useful to optimize early intervention. Among a geographically diverse patient population from the United States, we demonstrated that over half of pediatric patients undergoing proctocolectomy with ileal pouch–anal anastomosis for ulcerative colitis will develop pouchitis in the first 2 years after surgery.

Sections du résumé

BACKGROUND
Despite highly effective therapies, many children develop medically refractory ulcerative colitis (UC) and undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). We sought to determine the incidence, risk, and burden of pouchitis in the first 2 years following the final stage of IPAA in pediatric UC patients.
METHODS
Within the IQVIA Legacy PharMetrics Adjudicated Claims Database, we identified pediatric patients with UC who underwent proctocolectomy with IPAA between January 1, 2007, and June 30, 2015. We utilized International Classification of Diseases-Ninth Revision-Clinical Modification or International Classification of Diseases-Tenth Revision-Clinical Modification codes to identify patients with UC and Current Procedural Terminology codes to identify colectomy and IPAA. Continuous variables were compared using t tests and Wilcoxon rank sum testing, while categorical variables were compared using chi-square testing.
RESULTS
A total of 68 patients with an IPAA were identified. In the first 2 years following IPAA, the cumulative incidence of pouchitis was 54%. Patients with pouchitis required more outpatient visits in the first 2 years after IPAA (mean 21.8 vs 10.2; P = .006) and were more likely to be hospitalized compared with patients without pouchitis (46% vs 23%; P = .045). Patients with pouchitis also demonstrated higher mean total costs in year 1 and year 2 ($27 489 vs $8032 [P = .001] and $27 699 vs $6058 [P = .003], respectively).
CONCLUSIONS
Our findings confirm the high incidence of pouchitis demonstrated in earlier single-center studies of pediatric patients undergoing proctocolectomy with IPAA for UC. Identification of risk factors for pouchitis would be useful to optimize early intervention.
Among a geographically diverse patient population from the United States, we demonstrated that over half of pediatric patients undergoing proctocolectomy with ileal pouch–anal anastomosis for ulcerative colitis will develop pouchitis in the first 2 years after surgery.

Autres résumés

Type: plain-language-summary (eng)
Among a geographically diverse patient population from the United States, we demonstrated that over half of pediatric patients undergoing proctocolectomy with ileal pouch–anal anastomosis for ulcerative colitis will develop pouchitis in the first 2 years after surgery.

Identifiants

DOI: 10.1093/ibd/izab320 PMID: 35040995 PMC: PMC9434461
pubmed: 35040995
pii: 6510907
doi: 10.1093/ibd/izab320
pmc: PMC9434461
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

1332-1337

Subventions

Organisme : NIH HHS
ID : K23DK127157-01
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK127157
Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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Auteurs

Ellen Cowherd (E)

Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Matthew D Egberg (MD)

Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Michael D Kappelman (MD)

Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Xian Zhang (X)

Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Millie D Long (MD)

Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAand.

Amy L Lightner (AL)

Digestive Disease and Surgery Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.

Robert S Sandler (RS)

Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAand.

Hans H Herfarth (HH)

Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAand.

Edward L Barnes (EL)

Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAand.
ORCID: 0000-0001-9894-8796

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › The Cumulative Incidence of Pouchitis in...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies inflammatoires intestinales › Rectocolite hémorragique › The Cumulative Incidence of Pouchitis in...
questionsmedicales.fr › Équipement et fournitures › Reconstructions chirurgicales › Poches coliques › The Cumulative Incidence of Pouchitis in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The Cumulative Incidence of Pouchitis in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Incidence › The Cumulative Incidence of Pouchitis in...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies de l'iléon › Iléite › Pochite › The Cumulative Incidence of Pouchitis in...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Proctectomie › Proctocolectomie restauratrice › The Cumulative Incidence of Pouchitis in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › The Cumulative Incidence of Pouchitis in...