« Previous Next »Clinical Gastroenterology and Hepatology
Volume 4, Issue 1 , Pages 81-89, January 2006

Risk Factors for Diseases of Ileal Pouch–Anal Anastomosis After Restorative Proctocolectomy for Ulcerative Colitis

Bo Shen
- Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Address requests for reprints to: Bo Shen, MD, Department of Gastroenterology/Hepatology, Desk A30, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195; fax: (216) 444-6305
Victor W. Fazio
- Department of Colorectal Surgery, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Feza H. Remzi
- Department of Colorectal Surgery, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Aaron Brzezinski
- Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Ana E. Bennett
- Department of Anatomic Pathology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Rocio Lopez
- Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Department of Biostatistics, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Jeffrey P. Hammel
- Department of Biostatistics, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Jean-Paul Achkar
- Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Charles L. Bevins
- Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Department of Biostatistics, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Ian C. Lavery
- Department of Colorectal Surgery, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Scott A. Strong
- Department of Colorectal Surgery, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Conor P. Delaney
- Department of Colorectal Surgery, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Wendy Liu
- Department of Anatomic Pathology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Marlene L. Bambrick
- Department of Colorectal Surgery, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Kerry K. Sherman
- Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Bret A. Lashner
- Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

published online 30 December 2005.

Background & Aims: Although pouchitis is considered the most common adverse sequela of ileal pouch–anal anastomosis (IPAA), inflammatory and noninflammatory conditions other than pouchitis are increasingly being recognized. The risk factors for these non-pouchitis conditions, including Crohn’s disease (CD) of the pouch, cuffitis, and irritable pouch syndrome (IPS), have not been studied. The aim of this study was to assess risk factors for inflammatory and noninflammatory diseases of IPAA in a tertiary care setting. Methods: The study consisted of 240 consecutive patients who were classified as having healthy pouches (N = 49), pouchitis (N = 61), CD of the pouch (N = 39), cuffitis (N = 41), or IPS (N =50). Demographic and clinical features were assessed to determine risk factors for each of these conditions by using logistic regression analysis. Results: Risk factors remaining in the final logistic regression models were for pouchitis: IPAA indication for dysplasia (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.69–8.98), never having smoked (OR, 5.09; 95% CI, 1.01–25.69), no use of anti-anxiety agents (OR, 5.19; 95% CI, 1.45–18.59), or use of NSAIDs (OR, 3.24; 95% CI, 1.71–6.13); for CD of the pouch: a long duration of IPAA (OR, 1.20; 95% CI, 1.12–1.30) and current smoking (OR, 4.77; 95% CI, 1.39–16.25); for cuffitis: arthralgias (OR, 4.13; 95% CI, 1.91–8.94) and younger age (OR, 1.16; 95% CI, 1.01–1.33); and for IPS: use of antidepressants (OR, 4.17, 95% CI, 1.95–8.92) or anti-anxiety agents (OR, 3.21; 95% CI, 1.34–7.47). Conclusions: The majority of risk factors for the 4 inflammatory and noninflammatory conditions of IPAA are different, suggesting that each of these diseases has a different etiology and pathogenesis. The identification and modification of these risk factors might help patients and clinicians to make a preoperative decision for IPAA, reduce IPAA-related morbidity, and improve response to treatment.

Abbreviations used in this paper: ASCA, anti-Saccharomyces cerevisiae antibodies , CD, Crohn’s disease , CI, confidence interval , CMV, cytomegalovirus , IPAA, ileal pouch–anal anastomosis , IPS, irritable pouch syndrome , OR, odds ratio , PDAI, Pouchitis Disease Activity Index , PSC, primary sclerosing cholangitis , UC, ulcerative colitis