Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA.
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Dig Dis Sci. 2023 Jun;68(6):2188-2195. doi: 10.1007/s10620-023-07872-x. Epub 2023 Feb 18.
Pouchitis is the most frequent complication following restorative proctocolectomy and ileal pouch anal anastomosis (RP-IPAA) in patients with Ulcerative colitis (UC). Pediatric data on nutritional status during RP-IPAA and in patients with pouchitis are limited.
We aimed to delineate nutritional changes in children undergoing 2-stage and 3-stage surgeries and to evaluate the association between nutrition and the development of recurrent or chronic pouchitis.
This single-center retrospective study involved 46 children with UC who underwent a RP-IPAA. Data were collected at each surgical stage and for up to 2-year post-ileostomy takedown. We used Wilcoxon matched-pairs signed-rank test to evaluate the differences in nutritional markers across surgical stages and logistic regression to identify the factors associated with recurrent or chronic pouchitis.
Twenty patients (43.5%) developed recurrent or chronic pouchitis. Children who underwent a 3-stage procedure had improvements in albumin, hematocrit, and body mass index (BMI)-for-age Z-scores (p < 0.01) between the first two stages. A positive trend in BMI-for-age Z-scores (p = 0.08) was identified in children with 2-stage procedures. All patients showed sustained nutritional improvement during the follow-up period. Among patients who underwent 3-stage surgeries, BMI worsened by 0.8 standard deviations (SDs) (p = 0.24) between the initial stages in those who developed recurrent or chronic pouchitis and improved by 1.1 SDs (p = 0.04) in those who did not.
Early improvement in BMI-for-age Z-scores following the initial stage was associated with lower rates of recurrent or chronic pouchitis. Larger prospective studies are needed to validate these findings.
在溃疡性结肠炎（UC）患者中，经直肠结肠切除和回肠储袋肛管吻合术（RP-IPAA）后，储袋炎是最常见的并发症。儿科患者在 RP-IPAA 期间和患有储袋炎时的营养状况数据有限。
我们旨在描述接受两阶段和三阶段手术的儿童的营养变化，并评估营养与复发性或慢性储袋炎发展之间的关系。
这项单中心回顾性研究纳入了 46 例接受 RP-IPAA 的 UC 患儿。在每个手术阶段和回肠造口关闭后的 2 年内收集数据。我们使用 Wilcoxon 配对符号秩检验评估手术阶段之间营养标志物的差异，并使用逻辑回归识别与复发性或慢性储袋炎相关的因素。
20 例（43.5%）患儿发生复发性或慢性储袋炎。行三阶段手术的患儿在第一和第二阶段之间白蛋白、红细胞压积和体重指数（BMI）-年龄 Z 评分均有所改善（p < 0.01）。行两阶段手术的患儿 BMI-年龄 Z 评分呈正趋势（p = 0.08）。所有患者在随访期间均持续改善营养状况。在接受三阶段手术的患者中，发生复发性或慢性储袋炎的患者 BMI 在初始阶段之间恶化了 0.8 个标准差（SD）（p = 0.24），而未发生复发性或慢性储袋炎的患者则改善了 1.1 SD（p = 0.04）。
初始阶段后 BMI-年龄 Z 评分的早期改善与较低的复发性或慢性储袋炎发生率相关。需要更大规模的前瞻性研究来验证这些发现。
