Maia Kayal1, Ryan C Ungaro2, Alexa Riggs2, Kanika Kamal2, Manasi Agrawal2, Shirley Cohen-Mekelburg3, Jordan Axelrad4, Adam Faye2, Ellen Scherl5, Garrett Lawlor6, Keith Sultan7, Dana Lukin5, Marla C Dubinsky2, Jean Frederic Colombel2. 1. Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: maia.kayal@mountsinai.org. 2. Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan. 4. Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York, New York. 5. Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York. 6. Division of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York. 7. Division of Gastroenterology, Hepatology and Nutrition, Northwell Health, Great Neck, New York.
Abstract
BACKGROUND & AIMS: Disability in patients with medically refractory ulcerative colitis (UC) after total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is not well understood. The aim of this study was to compare disability in patients with IPAA vs medically managed UC, and identify predictors of disability. METHODS: This was a multicenter cross-sectional study performed at 5 academic institutions in New York City. Patients with medically or surgically treated UC were recruited. Clinical and socioeconomic data were collected, and the Inflammatory Bowel Disease Disability Index (IBD-DI) was administered to eligible patients. Predictors of moderate-severe disability (IBD-DI ≥35) were assessed in univariable and multivariable models. RESULTS: A total of 94 patients with IPAA and 128 patients with medically managed UC completed the IBD-DI. Among patients with IPAA and UC, 35 (37.2%) and 30 (23.4%) had moderate-severe disability, respectively. Patients with IPAA had significantly greater IBD-DI scores compared with patients with medically managed UC (29.8 vs 17.9; P < .001). When stratified by disease activity, patients with active IPAA disease had significantly greater median IBD-DI scores compared with patients with active UC (44.2 vs 30.4; P = .01), and patients with inactive IPAA disease had significantly greater median IBD-DI scores compared with patients with inactive UC (23.1 vs 12.5; P < .001). Moderate-severe disability in patients with IPAA was associated with female sex, active disease, and public insurance. CONCLUSIONS: Patients with IPAA have higher disability scores than patients with UC, even after adjustment for disease activity. Female sex and public insurance are predictive of significant disability in patients with IPAA.
BACKGROUND & AIMS: Disability in patients with medically refractory ulcerative colitis (UC) after total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is not well understood. The aim of this study was to compare disability in patients with IPAA vs medically managed UC, and identify predictors of disability. METHODS: This was a multicenter cross-sectional study performed at 5 academic institutions in New York City. Patients with medically or surgically treated UC were recruited. Clinical and socioeconomic data were collected, and the Inflammatory Bowel Disease Disability Index (IBD-DI) was administered to eligible patients. Predictors of moderate-severe disability (IBD-DI ≥35) were assessed in univariable and multivariable models. RESULTS: A total of 94 patients with IPAA and 128 patients with medically managed UC completed the IBD-DI. Among patients with IPAA and UC, 35 (37.2%) and 30 (23.4%) had moderate-severe disability, respectively. Patients with IPAA had significantly greater IBD-DI scores compared with patients with medically managed UC (29.8 vs 17.9; P < .001). When stratified by disease activity, patients with active IPAA disease had significantly greater median IBD-DI scores compared with patients with active UC (44.2 vs 30.4; P = .01), and patients with inactive IPAA disease had significantly greater median IBD-DI scores compared with patients with inactive UC (23.1 vs 12.5; P < .001). Moderate-severe disability in patients with IPAA was associated with female sex, active disease, and public insurance. CONCLUSIONS: Patients with IPAA have higher disability scores than patients with UC, even after adjustment for disease activity. Female sex and public insurance are predictive of significant disability in patients with IPAA.
Authors: Edward L Barnes; Parakkal Deepak; Poonam Beniwal-Patel; Laura Raffals; Maia Kayal; Marla Dubinsky; Shannon Chang; Peter D R Higgins; Jennifer I Barr; Joseph Galanko; Yue Jiang; Raymond K Cross; Millie D Long; Hans H Herfarth Journal: Crohns Colitis 360 Date: 2022-08-02