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 23 November 2017

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News

Differentiating risk factors for acute and chronic pouchitis

Postoperative use of non-steroidal anti-inflammatory drugs is a risk factor for chronic pouchitis and possibly for acute pouchitis, and thus should be discouraged for patients who undergo ileal pouch anal anastomosis, reports January's Clinical Gastroenterology and Hepatology.

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Pouchitis is the most common complication of ileal pouch anal anastomosis in patients with ulcerative colitis.

In some cases the inflammation becomes chronic and requires long-term medical therapy.

The clinical course and medical therapy are different between acute pouchitis and chronic pouchitis.

Dr Achkar and colleagues from Ohio in America undertook a study in order to determine if there are predictors of risk for acute vs chronic pouchitis.

The researchers matched 40 patients with acute pouchitis and 40 patients with chronic pouchitis with a control group who never had pouchitis (N = 40).

The research team then collected data for multiple pre-, peri-, and postoperative factors and performed follow-up telephone calls.

The researchers used case-control univariable analyses and multivariate logistic regression to measure the association between covariates and pouchitis.

Fulminant colitis leading to colectomy is protective from development of chronic pouchitis
Clinical Gastroenterology and Hepatology

On multivariate logistic regression, the researchers were able to show that extensive colonic disease and extraintestinal manifestations were associated with both acute and chronic pouchitis.

The researchers found that postoperative nonsteroidal anti-inflammatory drug (NSAID) use was associated with chronic pouchitis, but less so with acute pouchitis.

In addition, the research team noted that patients with fulminant colitis as an indication for surgery had a decreased risk for developing chronic pouchitis.

However, the team saw no such association for acute pouchitis.

Extensive colonic disease and preoperative extraintestinal manifestations are associated with increased risk for both acute and chronic pouchitis.

The researchers found that fulminant colitis leading to colectomy is protective from development of chronic pouchitis.

Dr Achkar concluded, "Postoperative use of NSAIDS is a risk factor for chronic pouchitis and possibly for acute pouchitis, and thus should be discouraged for patients who undergo ileal pouch anal anastomosis."

Clinical Gastroenterology and Hepatology; 2005: 3 (1): 60
19 January 2005

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