Koh Sharon Z, Zaghiyan Karen N, Li Quanlin, Rabizadeh Shervin, Melmed Gil Y, Targan Stephan R, Fleshner Phillip R
Divisions of Colon and Rectal Surgery and Gastroenterology, Departments of Surgery and Medicine, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California.
Inflamm Bowel Dis. 2016 Jun;22(6):1397-402. doi: 10.1097/MIB.0000000000000744.
Patients with inflammatory bowel disease-unclassified (IBDU) undergoing ileal pouch-anal anastomosis (IPAA) are at the risk of developing Crohn's disease (CD) after surgical procedure. In these patients, a clinically centered set of preoperative risk factors has not been prospectively defined. We report a single-center analysis of clinical factors associated with the development of CD after IPAA.
Consecutive IBDU patients undergoing IPAA were identified. The diagnosis of IBDU was based on the presence of atypical disease distribution, presence of granulomas on endoscopic biopsy, and/or perianal disease. The diagnosis of CD after IPAA included the presence of afferent limb inflammation on pouchoscopy in the absence of nonsteroidal anti-inflammatory drug use and/or the development of pouch fistulizing disease more than 3 months after ileostomy closure.
Of the 149 study patients, 33 (22%) were diagnosed with CD after IPAA at a median of 37 months (interquartile range, 11-83 mo) after ileostomy closure. CD was diagnosed by mucosal inflammation above the pouch (n = 23; 70%), pouch fistulizing disease (n = 4; 12%), anorectal septic complications (n = 2; 6%), or the presence of ≥2 of the above complications (n = 4; 12%). The sole clinical predictor for the development of CD after IPAA was younger age at disease onset even after controlling for relevant clinical factors in a multivariate analysis. The odds of developing CD increased by 4% for each year that IBDU was diagnosed at a younger age.
Younger age at disease onset is the only clinical factor associated with the development of CD after IPAA for IBDU. Patients with IBDU undergoing IPAA with young age at disease onset should be counseled about the potentially higher risk of developing CD.
接受回肠储袋肛管吻合术（IPAA）的炎症性肠病未定型（IBDU）患者在手术后有发生克罗恩病（CD）的风险。在这些患者中，尚未前瞻性地确定一套以临床为中心的术前风险因素。我们报告了一项关于IPAA术后发生CD相关临床因素的单中心分析。
确定连续接受IPAA的IBDU患者。IBDU的诊断基于非典型疾病分布、内镜活检有肉芽肿和/或肛周疾病。IPAA术后CD的诊断包括在未使用非甾体抗炎药的情况下袋状结肠镜检查发现输入袢炎症和/或回肠造口关闭后3个月以上出现储袋瘘管形成疾病。
149例研究患者中，33例（22%）在回肠造口关闭后中位37个月（四分位间距，11 - 83个月）被诊断为IPAA术后CD。CD通过储袋上方黏膜炎症（n = 23；70%）、储袋瘘管形成疾病（n = 4；12%）、肛肠感染性并发症（n = 2；6%）或上述并发症中≥2种的存在（n = 4；12%）来诊断。即使在多变量分析中控制了相关临床因素后，IPAA术后发生CD的唯一临床预测因素仍是发病时年龄较小。IBDU发病时年龄每小一岁，发生CD的几率增加4%。
发病时年龄较小是IBDU患者IPAA术后发生CD的唯一相关临床因素。对于发病时年龄较小且接受IPAA的IBDU患者，应告知其发生CD的潜在风险可能更高。
