Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Inflamm Bowel Dis. 2024 Feb 1;30(2):203-212. doi: 10.1093/ibd/izad054.
Patients with an ileal pouch-anal anastomosis (IPAA) can experience pouch inflammation postoperatively. The use of antitumor necrosis factor (anti-TNF) biologics may be associated with pouch inflammation, but limited data exist on the impact of multiple advanced therapies on development of subsequent pouch inflammation. The aim of this study was to assess for an association between preoperative use of multiple advanced therapies and risk of endoscopically detected inflammatory pouch diseases (EIPDs).
We performed a retrospective analysis of ulcerative colitis (UC) and indeterminate colitis (IBDU) patients who underwent an IPAA at a quaternary care center from January 2015 to December 2019. Patients were grouped based on number and type of preoperative drug exposures. The primary outcome was EIPD within 5 years of IPAA.
Two hundred ninety-eight patients were included in this analysis. Most of these patients had UC (95.0%) and demonstrated pancolonic disease distribution (86.1%). The majority of patients were male (57.4%) and underwent surgery for medically refractory disease (79.2%). The overall median age at surgery was 38.6 years. Preoperatively, 68 patients were biologic/small molecule-naïve, 125 received anti-TNF agents only, and 105 received non-anti-TNF agents only or multiple classes. Ninety-one patients developed EIPD. There was no significant association between type (P = .38) or number (P = .58) of exposures and EIPD, but older individuals had a lower risk of EIPD (P = .001; hazard ratio, 0.972; 95% confidence interval, 0.956-0.989).
Development of EIPD was not associated with number or type of preoperative advanced therapies.
接受回肠贮袋肛管吻合术（IPAA）的患者术后可能会出现贮袋炎症。使用抗肿瘤坏死因子（anti-TNF）生物制剂可能与贮袋炎症有关，但关于多种先进治疗方法对随后贮袋炎症发展的影响的数据有限。本研究旨在评估术前使用多种先进治疗方法与内镜检测到的炎症性贮袋疾病（EIPD）风险之间的关联。
我们对 2015 年 1 月至 2019 年 12 月在一家四级护理中心接受 IPAA 的溃疡性结肠炎（UC）和不确定结肠炎（IBDU）患者进行了回顾性分析。患者根据术前药物暴露的数量和类型进行分组。主要结局是 IPAA 后 5 年内出现 EIPD。
本分析共纳入 298 例患者。这些患者大多数患有 UC（95.0%），表现为全结肠炎分布（86.1%）。大多数患者为男性（57.4%），因药物难治性疾病接受手术（79.2%）。手术时的中位年龄为 38.6 岁。术前，68 例患者为生物制剂/小分子药物初治，125 例患者仅接受抗 TNF 药物治疗，105 例患者仅接受非抗 TNF 药物或多种药物治疗。91 例患者发生 EIPD。EIPD 与暴露类型（P =.38）或数量（P =.58）之间无显著关联，但年龄较大的患者 EIPD 风险较低（P =.001；风险比，0.972；95%置信区间，0.956-0.989）。
EIPD 的发生与术前先进治疗的数量或类型无关。
