BACKGROUND & AIMS: Pouchitis is a common complication of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis who have undergone colectomy. Pouchitis has been considered a single entity despite a broad array of clinical and endoscopic patterns. We developed a novel classification system based on the pattern of inflammation observed in pouches and evaluated the contributing factors and prognosis of each phenotype. METHODS: We identified 426 patients (384 with ulcerative colitis) treated with proctocolectomy and IPAA who subsequently underwent pouchoscopies at the University of Chicago between June 1997 and December 2019. We retrospectively reviewed 1359 pouchoscopies and classified them into 7 main pouch phenotypes: (1) normal, (2) afferent limb involvement, (3) inlet involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch with fistulas noted 6 months after ileostomy takedown. Logistic regression analysis was used to assess factors contributing to each phenotype. Pouch survival was estimated by the log-rank test and the Cox proportional hazards model. RESULTS: Significant contributing factors for afferent limb involvement were a body mass index of 25 or higher and hand-sewn anastomosis, for inlet involvement the significant contributing factor was male sex; for diffuse inflammation the significant contributing factors were extensive colitis and preoperative use of anti-tumor necrosis factor drugs, for cuffitis the significant contributing factors were stapled anastomosis and preoperative Clostridioides difficile infection. Inlet stenosis, diffuse inflammation, and cuffitis significantly increased the risk of pouch excision. Diffuse inflammation was associated independently with pouch excision (hazard ratio, 2.69; 95% CI, 1.34-5.41; P = .005). CONCLUSIONS: We describe 7 unique IPAA phenotypes with different contributing factors and outcomes, and propose a new classification system for pouch management and future interventional studies.
BACKGROUND & AIMS: Pouchitis is a common complication of ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis who have undergone colectomy. Pouchitis has been considered a single entity despite a broad array of clinical and endoscopic patterns. We developed a novel classification system based on the pattern of inflammation observed in pouches and evaluated the contributing factors and prognosis of each phenotype. METHODS: We identified 426 patients (384 with ulcerative colitis) treated with proctocolectomy and IPAA who subsequently underwent pouchoscopies at the University of Chicago between June 1997 and December 2019. We retrospectively reviewed 1359 pouchoscopies and classified them into 7 main pouch phenotypes: (1) normal, (2) afferent limb involvement, (3) inlet involvement, (4) diffuse, (5) focal inflammation of the pouch body, (6) cuffitis, and (7) pouch with fistulas noted 6 months after ileostomy takedown. Logistic regression analysis was used to assess factors contributing to each phenotype. Pouch survival was estimated by the log-rank test and the Cox proportional hazards model. RESULTS: Significant contributing factors for afferent limb involvement were a body mass index of 25 or higher and hand-sewn anastomosis, for inlet involvement the significant contributing factor was male sex; for diffuse inflammation the significant contributing factors were extensive colitis and preoperative use of anti-tumor necrosis factor drugs, for cuffitis the significant contributing factors were stapled anastomosis and preoperative Clostridioides difficile infection. Inlet stenosis, diffuse inflammation, and cuffitis significantly increased the risk of pouch excision. Diffuse inflammation was associated independently with pouch excision (hazard ratio, 2.69; 95% CI, 1.34-5.41; P = .005). CONCLUSIONS: We describe 7 unique IPAA phenotypes with different contributing factors and outcomes, and propose a new classification system for pouch management and future interventional studies.
Authors: P P Tekkis; R E Lovegrove; H S Tilney; J J Smith; P M Sagar; A J Shorthouse; N J Mortensen; R J Nicholls Journal: Colorectal Dis Date: 2009-02-17 Impact factor: 3.788
Authors: Ofer Ben-Bassat; Andrea D Tyler; Wei Xu; Richard Kirsch; David F Schaeffer; Joanna Walsh; A Hillary Steinhart; Gordon R Greenberg; Zane Cohen; Mark S Silverberg; Robin S McLeod Journal: Clin Gastroenterol Hepatol Date: 2013-09-27 Impact factor: 11.382
Authors: Mark A Samaan; Bo Shen; Mahmoud H Mosli; Guangyong Zou; William J Sandborn; Lisa M Shackelton; Sigrid Nelson; Larry Stitt; Stuart Bloom; Darrell S Pardi; Paolo Gionchetti; James Lindsay; Simon Travis; Ailsa Hart; Mark S Silverberg; Brian G Feagan; Geert R D'Haens; Vipul Jairath Journal: Gastrointest Endosc Date: 2018-04-13 Impact factor: 9.427
Authors: Marco Bertucci Zoccali; Neil H Hyman; Kinga B Skowron; Michele Rubin; Lisa M Cannon; Roger D Hurst; Konstantin Umanskiy; David T Rubin; Benjamin D Shogan Journal: Dis Colon Rectum Date: 2019-11 Impact factor: 4.585
Authors: Joseph Runde; Amarachi Erondu; Shintaro Akiyama; Cindy Traboulsi; Victoria Rai; Laura R Glick; Yangtian Yi; Jacob E Ollech; Russell D Cohen; Kinga B Skowron; Roger D Hurst; Konstatin Umanskiy; Benjamin D Shogan; Neil H Hyman; Michele A Rubin; Sushila R Dalal; Atsushi Sakuraba; Joel Pekow; Eugene B Chang; David T Rubin Journal: Inflamm Bowel Dis Date: 2022-09-01 Impact factor: 7.290