Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
Dig Dis Sci. 2023 Jul;68(7):3139-3147. doi: 10.1007/s10620-023-07947-9. Epub 2023 May 6.
Chronic inflammatory conditions of the pouch are common after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).
We aimed to investigate the relationship between acute pouchitis within 180 days of the final stage of IPAA surgery (very early pouchitis) and the future development of chronic antibiotic dependent pouchitis (CADP) and Crohn's-like disease of the pouch (CLDP).
We performed a retrospective cohort study, evaluating patients who underwent proctocolectomy with IPAA between January 1, 2004 and December 31, 2016. Multivariable logistic regression was used to evaluate the relationship between very early pouchitis and the development of CADP and CLDP.
Among 626 patients undergoing IPAA for UC, 137 (22%) developed very early pouchitis, 75 (12%) developed CADP, and 59 (9%) developed CLDP in a median follow-up of 5.18 years (interquartile range 0.94-10.8 years). Very early pouchitis was associated with a significant increase in the odds of developing CADP (adjusted odds ratio [aOR3.65, 95% CI 2.19-6.10) as was primary sclerosing cholangitis (aOR 3.97, 95% CI 1.44-11.0). Very early pouchitis was associated with increased odds for developing CLDP (aOR 2.77, 95% CI 1.54-4.98) along with a family history of inflammatory bowel disease (aOR 2.10, 95% CI 1.11-3.96).
In this cohort, very early pouchitis was associated with an increased risk of developing CADP and CLDP. These findings highlight very early pouchitis as a unique risk factor for chronic inflammatory conditions of the pouch and the need for future studies evaluating potential strategies for secondary prophylaxis strategies in this population.
在溃疡性结肠炎行回肠贮袋肛管吻合术（IPAA）后，贮袋的慢性炎症很常见。
我们旨在研究 IPAA 手术最后阶段（极早期贮袋炎） 180 天内发生的急性贮袋炎与慢性抗生素依赖型贮袋炎（CADP）和贮袋克罗恩样疾病（CLDP）的未来发展之间的关系。
我们进行了一项回顾性队列研究，评估了 2004 年 1 月 1 日至 2016 年 12 月 31 日期间行直肠结肠切除术并接受 IPAA 的患者。采用多变量逻辑回归评估极早期贮袋炎与 CADP 和 CLDP 发展之间的关系。
在 626 例因 UC 而行 IPAA 的患者中，137 例（22%）发生极早期贮袋炎，75 例（12%）发生 CADP，59 例（9%）在中位随访 5.18 年（四分位距 0.94-10.8 年）时发生 CLDP。极早期贮袋炎与发生 CADP 的几率显著增加相关（校正比值比[aOR]3.65，95%CI 2.19-6.10），原发性硬化性胆管炎也是如此（aOR 3.97，95%CI 1.44-11.0）。极早期贮袋炎与发生 CLDP 的几率增加相关（aOR 2.77，95%CI 1.54-4.98），同时伴有炎症性肠病家族史（aOR 2.10，95%CI 1.11-3.96）。
在本队列中，极早期贮袋炎与 CADP 和 CLDP 的发生风险增加相关。这些发现强调了极早期贮袋炎是贮袋慢性炎症的独特危险因素，需要进一步研究评估该人群中潜在二级预防策略的可能性。
