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. 2023 Dec 5;29(12):1907-1911.
doi: 10.1093/ibd/izad039.

Acute Severe Ulcerative Colitis Is Associated With an Increased Risk of Acute Pouchitis

Maia Kayal  1 , Hannah Posner  1 , Hadar Meringer Milwidsky  1 , Michael Plietz  2 , Sergey Khaitov  2 , Patricia Sylla  2 , Alexander Greenstein  2 , Marla C Dubinsky  1 , Saurabh Mehandru  1 , Jean Frederic Colombel  1
Affiliations

Acute Severe Ulcerative Colitis Is Associated With an Increased Risk of Acute Pouchitis

Maia Kayal et al. Inflamm Bowel Dis. .

Abstract

Background: Pouchitis occurs in up to 80% of patients after total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) and has been associated with microbial and host-related immunological factors. We hypothesized that a more robust immune response at the time of colectomy, manifested by acute severe ulcerative colitis (ASUC), may be associated with subsequent acute pouchitis.

Methods: This was a retrospective cohort analysis of all patients with UC or indeterminate colitis complicated by medically refractory disease or dysplasia who underwent TPC with IPAA at Mount Sinai Hospital between 2008 and 2017 and at least 1 subsequent pouchoscopy. Acute pouchitis was defined according to the Pouchitis Disease Activity Index. Cox regression was used to assess unadjusted relationships between hypothesized risk factors and acute pouchitis.

Results: A total of 416 patients met inclusion criteria. Of the 165 (39.7%) patients who underwent urgent colectomy, 77 (46.7%) were admitted with ASUC. Acute pouchitis occurred in 228 (54.8%) patients a median of 1.3 (interquartile range, 0.6-3.1) years after the final surgical stage. On multivariable analysis, ASUC (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.04-2.17) and a greater number of biologics precolectomy (HR, 1.57; 95% CI, 1.06-2.31) were associated with an increased probability of acute pouchitis, while older age at colectomy (HR, 0.98; 95% CI, 0.97-0.99) was associated with a decreased probability. Time to pouchitis was significantly less in patients admitted with ASUC compared with those not (P = .002).

Conclusion: A severe UC disease phenotype at the time of colectomy was associated with an increased probability of acute pouchitis.

Keywords: biologic; colectomy; pouchitis; ulcerative colitis.

Plain language summary

In a retrospective cohort analysis of 416 patients, acute severe ulcerative colitis at the time of colectomy was significantly associated with subsequent acute pouchitis. The risk of pouchitis may be driven by immune activation and disease severity precolectomy.

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Conflict of interest statement

M.K. has served as a consultant for GoodRx and AbbVie. M.C.D. has served as a consultant for AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim International, Bristol-Myers Squibb, Celgene, Eli Lilly, F. Hoffman-La Roche, Genentech, Gilead, Janssen, Pfizer, Prometheus, Takeda, and UCB; has received research grants from Pfizer, AbbVie, Janssen, and Prometheus; has ownership interest in Trellus; and has licensing fees from Takeda. S.M. has received research grants from Genentech and Takeda; payment for lectures from Takeda, Genentech, and Morphic; and consulting fees from Takeda, Morphic, Ferring, and Arena Pharmaceuticals. J.F.C. has received research grants from AbbVie, Janssen Pharmaceuticals and Takeda; received payment for lectures from AbbVie, Amgen, Allergan, Inc. Ferring Pharmaceuticals, Shire, and Takeda; has received consulting fees from AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, BMS, Celgene Corporation, Eli Lilly, Ferring Pharmaceuticals, Galmed Research, Genentech, Glaxo Smith Kline, Janssen Pharmaceuticals, Kaleido Biosciences, Imedex, Immunic, Iterative Scopes, Merck, Microbia, Novartis, PBM Capital, Pfizer, Protagonist Therapeutics, Sanofi,Takeda, TiGenix, and Vifor; and holds stock options in Intestinal Biotech Development.

Figures

Figure 1.
Figure 1.
Kaplan-Meier estimates of developing acute pouchitis in patients with vs without acute severe ulcerative colitis (ASUC).
See this image and copyright information in PMC

Comment in

References

    1. Lightner AL, Mathis KL, Dozois EJ, et al. Results at up to 30 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Inflamm Bowel Dis. 2017;23(5):781-790. - PubMed
    1. Landy J, Al-Hassi HO, McLaughlin SD, et al. Etiology of pouchitis. Inflamm Bowel Dis. 2012;18(6):1146-1155. - PubMed
    1. Shen B. Acute and chronic pouchitis--pathogenesis, diagnosis and treatment. Nat Rev Gastroenterol Hepatol. 2012;9(6):323-333. - PubMed
    1. Contijoch EJ, Britton GJ, Yang C, et al. Gut microbiota density influences host physiology and is shaped by host and microbial factors. Elife 2019;8:e40553. - PMC - PubMed
    1. Dalal RL, Shen B, Schwartz DA. Management of pouchitis and other common complications of the pouch. Inflamm Bowel Dis. 2018;24(5):989-996. - PubMed

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