Do clinical characteristics of de novo pouch Crohn's disease after restorative proctocolectomy affect ileal pouch retention?

BACKGROUND: Data on the association between ileal pouch retention and clinical characteristics of pouch Crohn's disease developing after restorative proctocolectomy for ulcerative colitis are still limited.

OBJECTIVE: The aim of this study was to identify whether clinical features of pouch Crohn's disease are associated with pouch retention.

SETTINGS: The study was conducted in a tertiary referral center.

DESIGN AND PATIENTS: All patients diagnosed with clinically active pouch Crohn's disease during follow-up after IPAA for ulcerative colitis or indeterminate colitis were identified from an ileal pouch registry. The definition of early vs late diagnosis was based on the median time interval to diagnosis of Crohn's disease after pouch creation. The associations between pouch retention and the clinical features and treatments of pouch Crohn's disease were analyzed.

OUTCOME MEASURE: The long-term pouch retention rate was estimated by using the Kaplan-Meier method. Multivariate logistic regression was used to analyze independent factors for pouch failure.

RESULTS: From 1993 to 2009, a total of 65 (28 males) patients developed de novo pouch Crohn's disease during a mean 7.9 years of follow-up after pouch creation. The overall pouch retention rate was 57%. The median time from pouch creation to pouch Crohn's disease diagnosis was 3.6 years. Univariate analysis demonstrated that early diagnosis of pouch Crohn's disease, disease location, and clinical manifestations at the time of diagnosis were associated with pouch outcomes, whereas medical therapy or perianal surgery was not. Multivariate analysis showed that fistula at the time of diagnosis (OR = 17.5, p = 0.002) and early diagnosis (OR = 5.70, p = 0.011) were independent risk factors for pouch failure, whereas afferent limb disease was associated with pouch retention (OR = 0.07, p = 0.018).

LIMITATIONS: The retrospective nature of this study and referral bias were limitations.

CONCLUSIONS: Disease characteristics of de novo pouch Crohn's disease heavily influence pouch retention. The interval from pouch construction, fistulizing disease, and disease location can be used as prognostic indicators when ileal pouch Crohn's disease is diagnosed.