Acute pouchitis after ileal pouch-anal anastomosis for ulcerative colitis is common and easily treated.
However, chronic pouchitis remains a difficult management issue.
Dr Phillip Fleshner and colleagues from California, USA identified important clinical risk factors associated with acute pouchitis or chronic pouchitis.
The team tabulated demographic, disease, and treatment characteristics were tabulated.
Univariate and multivariate analyses were performed to evaluate associations between acute pouchitis or chronic pouchitis and potential risk factors.
The researchers assessed 200 ileal pouch-anal anastomosis patients for a median of 24 months.
The team found that 18% of patients developed acute pouchitis, and 12% developed Chronic pouchitis.
|Steroids before colostomy was associated with acute pouchitis|
|Clinical Gastroenterology & Hepatology|
On univariate analysis, the use of steroids before colectomy and smoking were associated with the development of acute pouchitis.
The team found that chronic pouchitis was associated with male gender, smoking, length of follow-up, and extraintestinal manifestations.
In addition, the researchers noted that chronic pouchitis was associated with backwash ileitis, and elevated platelet count.
On multivariate analysis, several risk factors were found to be independently associated with acute pouchitis.
The researchers found that use of steroids before colostomy, and smoking were associated with acute pouchitis.
The team found chronic pouchitis was directly associated with extraintestinal manifestations.
Chronic pouchitis, elevated platelet count, and increased length of follow-up was directly associated with chronic pouchitis.
The research team noted that smoking reduced the incidence of chronic pouchitis.
Dr Fleshner's team concluded, "Clinical factors associated with acute pouchitis included use of steroids before colectomy and smoking."
"Factors directly related to chronic pouchitis were extraintestinal manifestations, elevated platelet count, and length of follow-up after ileal pouch-anal anastomosis."
"Smoking appears to protect against the development of chronic pouchitis."