The team determined the long-term outcome of ileal pouch anal anastomosis in patients with indeterminate colitis, compared with a cohort of patients with chronic ulcerative colitis. They reported their findings in the November issue of Diseases of the Colon and Rectum.
1437 patients with chronic ulcerative colitis and 82 patients with indeterminate colitis, who underwent an ileal pouch anal anastomosis between 1981 and 1995, were identified.
Median follow-up was 83 months.
At 10 years, patients with indeterminate colitis had significantly more episodes of pelvic sepsis (17 % indeterminate colitis vs. 7 % chronic ulcerative colitis), pouch fistula (31 vs. 9 %), and pouch failure (27 vs. 11 %).
During follow-up, 15 per cent of patients with indeterminate colitis had their original diagnosis changed to Crohn's disease. Only 2 per cent of patients with chronic ulcerative colitis had a changed diagnosis.
When the outcome of these patients newly diagnosed with Crohn's disease was considered separately, the complication rate for the remaining patients with indeterminate colitis was identical to those with chronic ulcerative colitis.
Where diagnosis of indeterminate colitis is changed to Crohn's disease after surgery, the long-term outcome is poor.
Dr John Pemberton said on behalf of the group that, "After ileal pouch anal anastomosis, patients with indeterminate colitis who did not develop Crohn's disease, subsequently experienced long-term outcomes nearly identical to patients with chronic ulcerative colitis.
"Crohn's disease, whether it develops after surgery for chronic ulcerative colitis or indeterminate colitis, is associated with poor long-term outcomes," he concluded.