Pouchitis Is a Common Complication in Patients With Familial Adenomatous Polyposis Following Ileal Pouch–Anal Anastomosis

Kevin P. Quinn, Amy Lightner, Richard S. Pendegraft, Felicity T Enders, Lisa Allyn Boardman, Laura E. H. Raffals

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background & Aims Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical procedure most commonly selected for patients with familial adenomatous polyposis (FAP) or ulcerative colitis that is refractive to medical treatment. Pouchitis is the most common complication in patients with ulcerative colitis after IPAA, but is thought to rarely occur in patients with FAP. We investigated the frequency of pouchitis and other pouch-related complications in patients with FAP after IPAA. Methods We performed a retrospective cohort study of all patients with FAP who underwent IPAA at a single tertiary institution from 1992 through 2015 (n = 113). Patients were identified using International Classification of Diseases-9 diagnostic and current procedural terminology codes. We obtained relevant demographic and clinical data from patients’ electronic medical records. The frequencies of pouchitis and pouch-related complications were determined. Results Twenty-five patients (22.1%) developed pouchitis (mean time to pouchitis, 4.1 years) and 88 did not (77.9%). Patients with pouchitis showed a trend toward developing late (>90 days after IPAA) pouch-related complications (56.0% of patients with pouchitis developed late complications, compared with 36.4% without). In patients who developed pouchitis, the disease course was acute in 72.0% and chronic in 28.0%. Of those treated, 69.6% responded to antibiotics, 13.0% became dependent on antibiotics, and 13.0% developed antibiotic resistance. Conclusions Pouchitis is more prevalent in patients with FAP than previously believed. Although pouchitis seems to occur later in patients with FAP than in patients with ulcerative colitis, and have a milder course, it should be considered a common complication among patients with FAP following IPAA.

Original languageEnglish (US)
Pages (from-to)1296-1301
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume14
Issue number9
DOIs
StatePublished - 2016

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Pouchitis
Adenomatous Polyposis Coli
Ulcerative Colitis
Surgical Anastomosis
Current Procedural Terminology
Restorative Proctocolectomy
Anti-Bacterial Agents
Electronic Health Records

Keywords

  • Colon
  • Inflammation
  • Prevalence
  • Surgery

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{fa766550a83240a48e1426935574f9c1,
title = "Pouchitis Is a Common Complication in Patients With Familial Adenomatous Polyposis Following Ileal Pouch–Anal Anastomosis",
abstract = "Background & Aims Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical procedure most commonly selected for patients with familial adenomatous polyposis (FAP) or ulcerative colitis that is refractive to medical treatment. Pouchitis is the most common complication in patients with ulcerative colitis after IPAA, but is thought to rarely occur in patients with FAP. We investigated the frequency of pouchitis and other pouch-related complications in patients with FAP after IPAA. Methods We performed a retrospective cohort study of all patients with FAP who underwent IPAA at a single tertiary institution from 1992 through 2015 (n = 113). Patients were identified using International Classification of Diseases-9 diagnostic and current procedural terminology codes. We obtained relevant demographic and clinical data from patients’ electronic medical records. The frequencies of pouchitis and pouch-related complications were determined. Results Twenty-five patients (22.1{\%}) developed pouchitis (mean time to pouchitis, 4.1 years) and 88 did not (77.9{\%}). Patients with pouchitis showed a trend toward developing late (>90 days after IPAA) pouch-related complications (56.0{\%} of patients with pouchitis developed late complications, compared with 36.4{\%} without). In patients who developed pouchitis, the disease course was acute in 72.0{\%} and chronic in 28.0{\%}. Of those treated, 69.6{\%} responded to antibiotics, 13.0{\%} became dependent on antibiotics, and 13.0{\%} developed antibiotic resistance. Conclusions Pouchitis is more prevalent in patients with FAP than previously believed. Although pouchitis seems to occur later in patients with FAP than in patients with ulcerative colitis, and have a milder course, it should be considered a common complication among patients with FAP following IPAA.",
keywords = "Colon, Inflammation, Prevalence, Surgery",
author = "Quinn, {Kevin P.} and Amy Lightner and Pendegraft, {Richard S.} and Enders, {Felicity T} and Boardman, {Lisa Allyn} and Raffals, {Laura E. H.}",
year = "2016",
doi = "10.1016/j.cgh.2016.04.010",
language = "English (US)",
volume = "14",
pages = "1296--1301",
journal = "Clinical Gastroenterology and Hepatology",
issn = "1542-3565",
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number = "9",

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T1 - Pouchitis Is a Common Complication in Patients With Familial Adenomatous Polyposis Following Ileal Pouch–Anal Anastomosis

AU - Quinn, Kevin P.

AU - Lightner, Amy

AU - Pendegraft, Richard S.

AU - Enders, Felicity T

AU - Boardman, Lisa Allyn

AU - Raffals, Laura E. H.

PY - 2016

Y1 - 2016

N2 - Background & Aims Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical procedure most commonly selected for patients with familial adenomatous polyposis (FAP) or ulcerative colitis that is refractive to medical treatment. Pouchitis is the most common complication in patients with ulcerative colitis after IPAA, but is thought to rarely occur in patients with FAP. We investigated the frequency of pouchitis and other pouch-related complications in patients with FAP after IPAA. Methods We performed a retrospective cohort study of all patients with FAP who underwent IPAA at a single tertiary institution from 1992 through 2015 (n = 113). Patients were identified using International Classification of Diseases-9 diagnostic and current procedural terminology codes. We obtained relevant demographic and clinical data from patients’ electronic medical records. The frequencies of pouchitis and pouch-related complications were determined. Results Twenty-five patients (22.1%) developed pouchitis (mean time to pouchitis, 4.1 years) and 88 did not (77.9%). Patients with pouchitis showed a trend toward developing late (>90 days after IPAA) pouch-related complications (56.0% of patients with pouchitis developed late complications, compared with 36.4% without). In patients who developed pouchitis, the disease course was acute in 72.0% and chronic in 28.0%. Of those treated, 69.6% responded to antibiotics, 13.0% became dependent on antibiotics, and 13.0% developed antibiotic resistance. Conclusions Pouchitis is more prevalent in patients with FAP than previously believed. Although pouchitis seems to occur later in patients with FAP than in patients with ulcerative colitis, and have a milder course, it should be considered a common complication among patients with FAP following IPAA.

AB - Background & Aims Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the surgical procedure most commonly selected for patients with familial adenomatous polyposis (FAP) or ulcerative colitis that is refractive to medical treatment. Pouchitis is the most common complication in patients with ulcerative colitis after IPAA, but is thought to rarely occur in patients with FAP. We investigated the frequency of pouchitis and other pouch-related complications in patients with FAP after IPAA. Methods We performed a retrospective cohort study of all patients with FAP who underwent IPAA at a single tertiary institution from 1992 through 2015 (n = 113). Patients were identified using International Classification of Diseases-9 diagnostic and current procedural terminology codes. We obtained relevant demographic and clinical data from patients’ electronic medical records. The frequencies of pouchitis and pouch-related complications were determined. Results Twenty-five patients (22.1%) developed pouchitis (mean time to pouchitis, 4.1 years) and 88 did not (77.9%). Patients with pouchitis showed a trend toward developing late (>90 days after IPAA) pouch-related complications (56.0% of patients with pouchitis developed late complications, compared with 36.4% without). In patients who developed pouchitis, the disease course was acute in 72.0% and chronic in 28.0%. Of those treated, 69.6% responded to antibiotics, 13.0% became dependent on antibiotics, and 13.0% developed antibiotic resistance. Conclusions Pouchitis is more prevalent in patients with FAP than previously believed. Although pouchitis seems to occur later in patients with FAP than in patients with ulcerative colitis, and have a milder course, it should be considered a common complication among patients with FAP following IPAA.

KW - Colon

KW - Inflammation

KW - Prevalence

KW - Surgery

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U2 - 10.1016/j.cgh.2016.04.010

DO - 10.1016/j.cgh.2016.04.010

M3 - Article

VL - 14

SP - 1296

EP - 1301

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

IS - 9

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