Open AccessFamily history of Crohn's disease is associated with an increased risk for Crohn's disease of the pouch
Author(s) -
Shen Bo,
Remzi Feza H.,
Hammel Jeffrey P.,
Lashner Bret A.,
Bevins Charles L.,
Lavery Ian C.,
Wehkamp Jan,
Fazio Victor W.
Publication year - 2009
Publication title -
inflammatory bowel diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.932
H-Index - 146
eISSN - 1536-4844
pISSN - 1078-0998
DOI - 10.1002/ibd.20646
Subject(s) - pouch , ulcerative colitis , pouchitis , medicine , proctocolectomy , crohn's disease , odds ratio , gastroenterology , family history , inflammatory bowel disease , logistic regression , confidence interval , disease , surgery
Background: Crohn's disease (CD) of the pouch can occur in patients with restorative proctocolectomy and ileal pouch–anal anastomosis originally performed for a preoperative diagnosis of ulcerative colitis (UC). CD of the pouch was often observed in patients with a family history of CD. The purpose was to determine whether the family history of CD increased the risk for CD of the pouch in patients who underwent restorative proctocolectomy. Methods: A total of 558 eligible patients seen in the Pouchitis Clinic were enrolled, including 116 patients with CD of the pouch and 442 patients with a normal pouch or other pouch disorders. Demographic and clinical variables were included in the study. Multivariable logistic regression analyses were performed. Results: The adjusted multivariate logistic analyses revealed that the risk for CD of the pouch was increased in patients with a family history of CD, with an odds ratio (OR) of 3.22 (95% confidence interval [CI] 1.56–6.67), or with a first‐degree relative with CD (OR = 4.18, 95% CI, 1.48–11.8), or with a greater number of family members with CD (OR = 2.00 per family member, 95% CI, 1.19–3.37), adjusting for age, gender, smoking status, duration of IBD, duration of having a pouch, and a preoperation diagnosis of indeterminate colitis or CD. In addition, patients of younger age and longer duration of having a pouch had a higher risk for CD of the pouch. A diagnosis of CD of the pouch was associated with a poor outcome, with a greater than 5‐fold estimated increased odds of pouch failure (OR = 5.58, 95% CI, 2.74–11.4). Conclusions The presence of a family history of CD is associated with an increased risk for CD of the pouch, which in turn has a high risk for pouch failure. (Inflamm Bowel Dis 2008)