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Recommendation of care varies for women with ulcerative colitis postileal pouch–anal anastomosis

The latest issue of the Digestive Diseases and Sciences reports significant variation in recommendation of care for women of reproductive age with ulcerative colitis postileal pouch–anal anastomosis.

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Ileal pouch–anal anastomosis (IPAA) is the preferred surgical option for treatment refractory ulcerative colitis.

Infertility risk post IPAA and sphincter injury concerns with vaginal delivery has led to a lack of consensus regarding timing and recommended mode of delivery post-IPAA.

To better understand these issues, Dr Kara Bradford and colleagues surveyed gastroenterologists, colorectal surgeons, and obstetricians to assess practice variation in recommendations for delivery post IPAA.

Clinical vignettes were developed to assess knowledge, attitudes, and beliefs surrounding the impact of IPAA on fertility, IPAA timing around pregnancy, recommended mode of delivery after IPAA, and which specialist should advise on MOD.

These were emailed to providers using specialty society address lists.

Univariate analyses tested differences among groups.
The majority of gastroenterologists quoted fertility reduction of more than 20% post-IPAA
Digestive Diseases & Sciences

The team reported that a total of 244 gastroenterologists, 158 colorectal surgeons and 39 obstetricians responded to the survey.

The majority of gastroenterologists and colorectal surgeons quoted fertility reduction of more than 20% post-IPAA versus 11% obstetricians.

More GI than colorectal surgeons recommended delaying IPAA until after pregnancy, and this was more commonly suggested by colorectal surgeons in practice less than 10 years, and less than 45 years old.

The research team recommended vaginal delivery post-IPAA in 43%, 20% and 57% for gastroenterologists, colorectal surgeons and obstetricians, respectively.

The team found that only 28% colorectal surgeons versus 59% obstetricians thought obstetricians should primarily advise on mode of delivery.

Dr Bradford's team concludes, "There is significant intra- and inter-group variation in management of women post-IPAA."

"There is need for consensus among subspecialists involved in managing women with this complex condition."

Dig Dis Sci 2014: 59(6): 1115-1120
19 June 2014

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