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The outcome of ulcerative colitis patients undergoing pouch surgery is determined by pre‐surgical factors
Author(s) -
Yanai H.,
BenShachar S.,
Mlynarsky L.,
Godny L.,
Leshno M.,
Tulchinsky H.,
Dotan I.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14205
Subject(s) - pouchitis , medicine , ulcerative colitis , pouch , cohort , surgery , proctocolectomy , gastroenterology , disease
Summary Background Pouch surgery, a common intervention for ulcerative colitis (UC) complications, is often associated with the development of pouchitis. Aim To identify predictors of pouch outcome in a cohort of patients with UC. Methods We conducted a retrospective unmatched case‐cohort study in a tertiary IBD referral centre. Adult patients with UC were classified into the worst phenotype throughout follow‐up: normal pouch, a form of chronic pouchitis (either chronic pouchitis or Crohn's like disease of pouch [CLDP]), or episodic recurrent acute pouchitis (RAP). Risk factors for pouchitis (chronic forms) were detected using statistical models. Results Two hundred and fifty‐three pouch patients were followed up for 13.1±7.3 years. Only 71 patients (28.1%) maintained a favourable outcome of a sustained normal pouch. These patients were older at UC diagnosis (27.8±12.5 vs 23.0±11.4 years), had longer UC duration until surgery (13.4±9.5 vs 8.2±7.9 years), and had higher rates of referral to surgery due to nonrefractory (dysplasia/neoplasia) complications (42.3% vs 16.2%) compared with pouchitis patients. Median survival for sustained normal pouch was 10.8 years (95% CI 8.9‐12.7 years), and it was longer in the nonrefractory group (20.3 vs 9.4 years for the refractory group, HR=2.37, 95% CI 1.25‐3.52, P =.004). Conclusions Most patients with UC undergoing pouch surgery will develop pouchitis. Patients operated for nonrefractory indications have a more favourable outcome. These results may contribute to pre‐ and post‐surgical decision‐making. The findings imply that the processes determining UC severity may be similar to that causing pouchitis.