Evaluation of preoperative predictors of development of pouchitis after ileal-pouch-anastomosis in ulcerative colitis

Kalkan, İsmail Hakkı; Dağlı, Ülkü; Önder, Fatih; Tunç, Bilge; Öztaş, Erkin; Ülker, Aysel; Şaşmaz, Nurgül

doi:10.1016/j.clinre.2012.04.012

Cited by 27 publications

(31 citation statements)

References 24 publications

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“…Previous studies have also reported a significant relationship between the occurrence of pouchitis and preoperative steroid use [13,23]. Fleshner et al [13] reported that clinical factors associated with the development of acute pouchitis include the use of a steroid before colectomy, whereas factors directly related to chronic pouchitis were extraintestinal manifestations, an elevated platelet count, and increased length of follow-up after IPAA.…”

Section: Discussionmentioning

confidence: 99%

“…They showed that although patients with more aggressive disease may have a higher incidence of pouchitis after surgery, this trend was not seen in patients taking other more potent immunosuppressive agents before IPAA [13]. Kalkan et al [23] reported that a high preoperative PDAI score and steroid dependency are independent predictive factors for the development of pouchitis. They suggested that more severe disease activity in the preoperative period may pose an increased risk for the development of pouchitis.…”

Section: Discussionmentioning

confidence: 99%

“…The implications of these studies include younger age at onset [10,15], younger age at colectomy [4], extensive colitis [12,17,18], backwash ileitis [4,8], extraintestinal manifestations [2,4,8,9,10,11], preoperative steroid use [13,23], smoking status [13,24,25], regular use of nonsteroidal anti-inflammatory drugs [14,24], preoperative perinuclear antineutrophil cytoplasmic antibody positivity [22,25,26], anti-CBir1 flagellin [22], and genetic factors (IL-1 receptor antagonist, NOD2/CARD 15, and TNF genes) [27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

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Predictive Factors for Development of Chronic Pouchitis after Ileal Pouch-Anal Anastomosis in Ulcerative Colitis

Okita

Araki²,

Hashimoto³

et al. 2013

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Background: No previous studies have examined predictive factors for chronic pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) with consideration of changes in pouchitis subtypes during follow-up. This study evaluated the independent predictive factors for chronic pouchitis. Methods: A total of 244 consecutive patients who underwent IPAA were enrolled. We assessed the possible associations between pouchitis and clinical factors using Cox proportional hazard regression. Results: 231 patients met the inclusion criteria. 66 (28.5%) patients developed pouchitis. In 9 of 44 (20.4%) patients, antibiotic-responsive pouchitis at the first episode changed into chronic pouchitis after the occurrence of a subsequent episode. The median duration from occurrence of antibiotic-responsive pouchitis to alteration into chronic pouchitis was 502 (range 147-1,697) days. Overall pouchitis was finally classified into 35 acute pouchitis and 31 chronic pouchitis cases. Multivariate analysis revealed that a ≥7.5-g cumulative steroid dose before colectomy and a ≥500-mg monthly steroid dose just before colectomy were significant predictive factors for chronic pouchitis (p = 0.0001 and 0.0095, respectively). Conclusion: Patients with UC and a higher cumulative steroid dose before colectomy or higher monthly steroid dose just before colectomy may have a predictive factor for developing chronic pouchitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictive Factors for Development of Chronic Pouchitis after Ileal Pouch-Anal Anastomosis in Ulcerative Colitis

Okita

Araki²,

Hashimoto³

et al. 2013

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“…Although the mechanism underlying the development pouchitis remains unclear, several studies have reported an increased incidence of pouchitis in patients with a shorter disease duration of UC [4], extent of colitis [4,8,20], younger age [8], and more severe preoperative clinical course of UC [21]. Additionally, it is considered that extraintestinal manifestations [8,[22][23][24][25], especially primary sclerosing cholangitis [26][27][28], are significant predictors of pouchitis development.…”

Section: Discussionmentioning

confidence: 99%

Colonic Histological Criteria Predict Development of Pouchitis after Ileal Pouch: Anal Anastomosis for Patients with Ulcerative Colitis

Araki

Hashimoto²,

Okita³

et al. 2017

Dig Surg

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Background/Aims: Pouchitis is one of the main complications after ileal pouch-anal anastomosis in patients with ulcerative colitis. The aim of this study was to determine whether the use of colonic histological criteria can predict the development of pouchitis. Methodology: We retrospectively reviewed 147 patients' clinical data and performed a histological evaluation of the resected total colon using Tanaka's criteria, which comprise the following 6 factors: ulceration (H₁), crypt abscesses (H₂), degree of mononuclear cell infiltration (MNCI) (H₃), segmental distribution of MNCI (H₄), eosinophil infiltration (H₅), and extent of disease of resected colon (H₆). Results: The development of pouchitis and chronic pouchitis within 3 years after restoration of gastrointestinal continuity was recognized in 52 (35.4%) and 26 (17.7%) of the 147 patients, respectively. Using various combinations of each score, the H₃ + H₄ - H₅ scores of patients with pouchitis or chronic pouchitis were significantly higher than those of patients without. A H₃ + H₄ - H₅ score of >0.4 was a statistically significant risk factor for the development of both pouchitis and chronic pouchitis. Conclusions: The combination of the degree of MNCI, segmental distribution of MNCI, and eosinophil infiltration from histological criteria has utility in predicting the future development of pouchitis, especially chronic pouchitis.

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“…This data differs from other countries where 34% was reported in Scotland [26] and 21.7% in Brazil [27], and differ widely from China (5.3%) [29] and Japan (10%) [30]. To date, there is still no clear explanation for this fact, but it may be influenced by ethnic background, geographic location [35], genetic information [36], diet [37] and some features of the UC, for example, the clinical course [38]. In our study, 20.6% of the patients had active acute pouchitis and 35.3% presented pouchitis in remission due to the adequate response to antibiotic treatment, in contrast with United States where 96% of the patients responded to antibiotic treatment [23].…”

Section: Discussionmentioning

confidence: 99%

Frequency, Clinical Features and Factors Associated with Pouchitis after Proctocolectomy with Ileo-Pouch-Anal Anastomosis in Patients with Ulcerative Colitis: A Latin-American Country Retrospective-Cohort Study

Yamamoto-Furusho

Aguilar

2015

Dig Surg

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Background: Pouchitis is the most common complication of proctocolectomy with ileo-pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). No previous study in Mexico has evaluated this issue; our aim was to evaluate its frequency, clinical characteristics and factors associated with its presence in Mexican patients with UC and IPAA. Methods: Retrospective-cohort study including 70 patients with histopathological diagnosis of UC and IPAA between 1983 and 2014 from inflammatory bowel disease clinic of a tertiary care center. The statistical analysis used descriptive statistics, chi-square and Fisher's exact test for categorical variables and Student's t test for numeric variables. Univariate analysis was performed to identify the factors associated. Results: Patients presenting with pouchitis accounted for 48.6%. From the 34 cases, 12 (35.3%) had inactive pouchitis; 7 (20.6%) active acute pouchitis; 15 (44.1%) chronic active pouchitis. On average, pouchitis occurred 5.37 years after IPPA. Factors probably associated with its occurrence were the presence of autoimmune concomitant diseases (ACDs; p = 0.06, OR 4.40, 95% CI 0.84-22.9) and extra-intestinal manifestations (EIMs; p = 0.05, OR 2.53, 95% CI 0.96-6.64), which was also probably associated with chronic active pouchitis (p = 0.06, OR 0.31, 95% CI 0.07-1.31). Conclusions: The frequency of pouchitis is high in Mexican UC patients after IPAA. ACDs and EIMs were probably associated with its development.

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Evaluation of preoperative predictors of development of pouchitis after ileal-pouch-anastomosis in ulcerative colitis

Cited by 27 publications

References 24 publications

Predictive Factors for Development of Chronic Pouchitis after Ileal Pouch-Anal Anastomosis in Ulcerative Colitis

Predictive Factors for Development of Chronic Pouchitis after Ileal Pouch-Anal Anastomosis in Ulcerative Colitis

Colonic Histological Criteria Predict Development of Pouchitis after Ileal Pouch: Anal Anastomosis for Patients with Ulcerative Colitis

Frequency, Clinical Features and Factors Associated with Pouchitis after Proctocolectomy with Ileo-Pouch-Anal Anastomosis in Patients with Ulcerative Colitis: A Latin-American Country Retrospective-Cohort Study

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