Transmural Inflammation, Ileitis, and Granulomas at the Time of Proctocolectomy in Patients with Ulcerative Colitis Do Not Predict Future Development of Pouchitis.

Background: The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis. Our study aimed to investigate the relationship between histopathologic findings of ileitis, granuloma, or transmural inflammation on the colectomy specimen of patients with clinically and endoscopically diagnosed UC and the development of pouchitis within the first 2 years after IPAA.
Methods: We performed a retrospective cohort study evaluating patients undergoing colectomy with IPAA for UC between January 1, 2004 and December 31, 2016. Bivariate analyses were conducted to evaluate the relationship between clinical factors and the development of pouchitis. We performed multivariate logistic regression to evaluate the relationship between histologic, clinical, and demographic factors at the time of colectomy and subsequent development of pouchitis.
Results: Among 626 patients, pouchitis occurred in 246 (39%). Patients with primary sclerosing cholangitis were more likely to develop pouchitis (adjusted odds ratio [aOR] 2.81, 95% confidence interval [CI] 1.02-7.72), as were patients with a family history of inflammatory bowel disease (aOR 1.75, 95% CI 1.11-2.77). Histologic findings of ileitis, granuloma, or transmural inflammation were not associated with an increased odds of developing pouchitis (aOR 0.70, 95% CI 0.45-1.08).
Discussion/conclusion: Patients with ileitis, granulomas, or transmural inflammation at the time of colectomy were not at greater risk for development of pouchitis in the 2 years after IPAA. These pathological findings should not preclude IPAA for UC.
Competing Interests: Edward L. Barnes has served as a consultant for AbbVie, Gilead, Pfizer, Takeda, and Target RWE. Bharati Kochar has served as a consultant for Pfizer. Michael D. Kappelman has served as a consultant for Abbvie, Takeda, Janssen, and Eli Lilly and has received research support from Abbvie and Janssen. Millie D. Long has served as a consultant for AbbVie, UCB, Takeda, Janssen, Pfizer, Salix, Valeant, and Target Pharmasolutions and has received research support from Pfizer and Takeda. Hans H. Herfarth has served as a consultant for Alivio, AMAG, Finch, Gilead, Lycera, Merck, Otsuka, Pfizer, PureTech, and Seres and research support from Pfizer and Artizan Biosciences. Joshua Hudson, Scott Esckilsen, Mark Koruda, and Robert S. Sandler have no relevant disclosures or conflicts of interest.
(Copyright © 2021 by S. Karger AG, Basel.)