Diagnostic value of esophagogastroduodenoscopy in patients with ileal pouch-anal anastomosis.

BACKGROUND: Inflammatory and noninflammatory complications of ileal pouch-anal anastomosis (IPAA) are common after restorative proctocolectomy of ulcerative colitis (UC). Some of the patients can have upper gastrointestinal pathology. The diagnostic role of esophagogastroduodenoscopy (EGD) in these patients has not been evaluated. The aim was to estimate the prevalence of upper gastrointestinal (GI) diseases detected by EGD and to assess factors associated with the abnormal EGD findings.

METHODS: IPAA patients with underlying inflammatory bowel disease undergoing diagnostic EGD were recruited from a subspecialty pouchitis clinic. Diagnostic yield and incidental findings of EGD were evaluated. Twenty-three variables were evaluated including age, gender, UC duration, IPAA duration, the Pouchitis Disease Activity Index scores, pouch type, pre-IPAA diagnosis, and disease category of the pouch. Univariate and multivariate analyses were performed; stepwise selection with 0.35 and 0.10 as entry and exit criteria.

RESULTS: Sixty-six patients undergoing EGD were enrolled in the study, of whom 64 (97%) patients had a concomitant pouch endoscopy. Indications for EGD include anemia, upper abdominal pain, weight loss, nausea and vomiting, and persistent diarrhea refractory to antibiotic therapy. Seventeen patients (25.8%) had a conclusive diagnosis and 14 (21.2%) had incidental findings, on EGD. The most common abnormal findings on EGD were Crohn's disease 12%), peptic ulcer disease (3%), gastritis/duodenitis on histology (11%), Candida esophagitis (3%), and arteriovenous malformations (3%). In multivariate analysis, factors associated with a conclusive EGD diagnosis were a high Pouchitis Disease Activity Index endoscopy score of the afferent limb (odds ratio [OR] = 1.8; 95% confidence interval [CI]: 1.09, 2.9; P = 0.02) and pouch types other than original J pouch (OR = 5.9; 95% CI: 1.08, 32.2; P = 0.041).

CONCLUSIONS: EGD evaluation can yield valuable diagnostic information in selected symptomatic patients with IPAA.