Relationship Between Stages of Ileal Pouch-Anal Anastomosis, Timing of Restoration of Fecal Continuity, and Pouchitis
Background The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis. Aims We aimed to investigate whether a shorter period between pouch creation and restoration of fecal flow through an IPAA was associated with an increased ris...
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| Veröffentlicht in: | Digestive diseases and sciences 2022-11, Vol.67 (11), p.5220-5226 |
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| creator | Sherrill, Gary C. Esckilsen, Scott Hudson, Joshua Kochar, Bharati Herfarth, Hans H. Barnes, Edward L. |
| description | Background
The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis.
Aims
We aimed to investigate whether a shorter period between pouch creation and restoration of fecal flow through an IPAA was associated with an increased risk of development of pouchitis within the first 2 years after IPAA.
Methods
We performed a retrospective cohort study evaluating patients undergoing colectomy with IPAA for UC between January 1, 2004 and December 31, 2016. We used Kaplan–Meier testing and Cox Proportional Hazards Modeling to evaluate the relationship between the time between restoration of fecal continuity and time to subsequent development of pouchitis, adjusting for other clinical and demographic factors.
Results
We identified 624 patients who underwent proctocolectomy with IPAA for UC, of whom 246 (39%) developed pouchitis within the first 2 years after IPAA. There was no difference when comparing the median time to restoration of continuity among those patients who developed pouchitis and those who did not (49 days vs. 49 days,
p
= 0.85) or in multivariable analysis. Primary sclerosing cholangitis (Hazard Ratio [HR] 2.14, 95% CI 1.12–4.08), family history of inflammatory bowel disease (HR 1.49, 95% CI 1.08–2.06), and delayed pouch creation (HR 0.75, 95% CI 0.57–1.00) were significantly associated with time to development of pouchitis.
Conclusion
Although a staged approach to IPAA may have benefits in the surgical management of UC, the timing interval between pouch creation and restoration of continuity did not impact the subsequent development of early pouchitis in this cohort. |
| doi_str_mv | 10.1007/s10620-022-07440-9 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2636154888</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A723794887</galeid><sourcerecordid>A723794887</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-d0585c91841cc3c840834962e3095a208f31decceef7eff9beca14a6db9020143</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi0EokvhD3BAkbhwaMr4I_44blcUKlUClXK2vM5k6yqxlzgR6r_H2xQqEEIj2ePxM689egl5TeGUAqj3mYJkUANjNSghoDZPyIo2iteskfopWQGVJadUHpEXOd8CgFFUPidHvGFCauArMl9h76aQYr4J--oMpx-Isfo6uR3mKnXVRY-ur76k2d_U61jSsuQpDSmHfFJdhyHE3YG7wlId75UOx3P0hd2kOIU4h-nupHKxXWTCFPJL8qxzfcZXD_sx-Xb-4Xrzqb78_PFis76svRBsqltodOMN1YJ6z70WoLkwkiEH0zgGuuO0Re8RO4VdZ7blVSqcbLcGGFDBj8m7RXc_pu9z-aIdQvbY9y5imrNlkkvaCK11Qd_-hd6meSwTF0qV0Fwx-kjtXI82xC5No_MHUbtWjCtTtFShTv9BlWhxCD5F7EKp_9HAlgY_ppxH7Ox-DIMb7ywFe_DaLl7b4rW999qa0vTm4cfzdsD2d8svcwvAFyCXq7jD8XGk_8j-BL-fspc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2727283721</pqid></control><display><type>article</type><title>Relationship Between Stages of Ileal Pouch-Anal Anastomosis, Timing of Restoration of Fecal Continuity, and Pouchitis</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Sherrill, Gary C. ; Esckilsen, Scott ; Hudson, Joshua ; Kochar, Bharati ; Herfarth, Hans H. ; Barnes, Edward L.</creator><creatorcontrib>Sherrill, Gary C. ; Esckilsen, Scott ; Hudson, Joshua ; Kochar, Bharati ; Herfarth, Hans H. ; Barnes, Edward L.</creatorcontrib><description>Background
The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis.
Aims
We aimed to investigate whether a shorter period between pouch creation and restoration of fecal flow through an IPAA was associated with an increased risk of development of pouchitis within the first 2 years after IPAA.
Methods
We performed a retrospective cohort study evaluating patients undergoing colectomy with IPAA for UC between January 1, 2004 and December 31, 2016. We used Kaplan–Meier testing and Cox Proportional Hazards Modeling to evaluate the relationship between the time between restoration of fecal continuity and time to subsequent development of pouchitis, adjusting for other clinical and demographic factors.
Results
We identified 624 patients who underwent proctocolectomy with IPAA for UC, of whom 246 (39%) developed pouchitis within the first 2 years after IPAA. There was no difference when comparing the median time to restoration of continuity among those patients who developed pouchitis and those who did not (49 days vs. 49 days,
p
= 0.85) or in multivariable analysis. Primary sclerosing cholangitis (Hazard Ratio [HR] 2.14, 95% CI 1.12–4.08), family history of inflammatory bowel disease (HR 1.49, 95% CI 1.08–2.06), and delayed pouch creation (HR 0.75, 95% CI 0.57–1.00) were significantly associated with time to development of pouchitis.
Conclusion
Although a staged approach to IPAA may have benefits in the surgical management of UC, the timing interval between pouch creation and restoration of continuity did not impact the subsequent development of early pouchitis in this cohort.</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-022-07440-9</identifier><identifier>PMID: 35246803</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Analysis ; Anastomosis, Surgical - adverse effects ; Biochemistry ; Cholangitis ; Colitis, Ulcerative - complications ; Colitis, Ulcerative - surgery ; Electronic health records ; Feces ; Gastroenterology ; Hepatology ; Humans ; Inflammatory bowel disease ; Medical colleges ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Microbiota ; Oncology ; Original Article ; Ostomy ; Patients ; Pouchitis - etiology ; Proctocolectomy, Restorative - adverse effects ; Retrospective Studies ; Surgery ; Transplant Surgery ; Ulcerative colitis</subject><ispartof>Digestive diseases and sciences, 2022-11, Vol.67 (11), p.5220-5226</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>COPYRIGHT 2022 Springer</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-d0585c91841cc3c840834962e3095a208f31decceef7eff9beca14a6db9020143</citedby><cites>FETCH-LOGICAL-c442t-d0585c91841cc3c840834962e3095a208f31decceef7eff9beca14a6db9020143</cites><orcidid>0000-0001-9894-8796</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-022-07440-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-022-07440-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35246803$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sherrill, Gary C.</creatorcontrib><creatorcontrib>Esckilsen, Scott</creatorcontrib><creatorcontrib>Hudson, Joshua</creatorcontrib><creatorcontrib>Kochar, Bharati</creatorcontrib><creatorcontrib>Herfarth, Hans H.</creatorcontrib><creatorcontrib>Barnes, Edward L.</creatorcontrib><title>Relationship Between Stages of Ileal Pouch-Anal Anastomosis, Timing of Restoration of Fecal Continuity, and Pouchitis</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background
The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis.
Aims
We aimed to investigate whether a shorter period between pouch creation and restoration of fecal flow through an IPAA was associated with an increased risk of development of pouchitis within the first 2 years after IPAA.
Methods
We performed a retrospective cohort study evaluating patients undergoing colectomy with IPAA for UC between January 1, 2004 and December 31, 2016. We used Kaplan–Meier testing and Cox Proportional Hazards Modeling to evaluate the relationship between the time between restoration of fecal continuity and time to subsequent development of pouchitis, adjusting for other clinical and demographic factors.
Results
We identified 624 patients who underwent proctocolectomy with IPAA for UC, of whom 246 (39%) developed pouchitis within the first 2 years after IPAA. There was no difference when comparing the median time to restoration of continuity among those patients who developed pouchitis and those who did not (49 days vs. 49 days,
p
= 0.85) or in multivariable analysis. Primary sclerosing cholangitis (Hazard Ratio [HR] 2.14, 95% CI 1.12–4.08), family history of inflammatory bowel disease (HR 1.49, 95% CI 1.08–2.06), and delayed pouch creation (HR 0.75, 95% CI 0.57–1.00) were significantly associated with time to development of pouchitis.
Conclusion
Although a staged approach to IPAA may have benefits in the surgical management of UC, the timing interval between pouch creation and restoration of continuity did not impact the subsequent development of early pouchitis in this cohort.</description><subject>Analysis</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Biochemistry</subject><subject>Cholangitis</subject><subject>Colitis, Ulcerative - complications</subject><subject>Colitis, Ulcerative - surgery</subject><subject>Electronic health records</subject><subject>Feces</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Inflammatory bowel disease</subject><subject>Medical colleges</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Microbiota</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Pouchitis - etiology</subject><subject>Proctocolectomy, Restorative - adverse effects</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Transplant Surgery</subject><subject>Ulcerative colitis</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU1v1DAQhi0EokvhD3BAkbhwaMr4I_44blcUKlUClXK2vM5k6yqxlzgR6r_H2xQqEEIj2ePxM689egl5TeGUAqj3mYJkUANjNSghoDZPyIo2iteskfopWQGVJadUHpEXOd8CgFFUPidHvGFCauArMl9h76aQYr4J--oMpx-Isfo6uR3mKnXVRY-ur76k2d_U61jSsuQpDSmHfFJdhyHE3YG7wlId75UOx3P0hd2kOIU4h-nupHKxXWTCFPJL8qxzfcZXD_sx-Xb-4Xrzqb78_PFis76svRBsqltodOMN1YJ6z70WoLkwkiEH0zgGuuO0Re8RO4VdZ7blVSqcbLcGGFDBj8m7RXc_pu9z-aIdQvbY9y5imrNlkkvaCK11Qd_-hd6meSwTF0qV0Fwx-kjtXI82xC5No_MHUbtWjCtTtFShTv9BlWhxCD5F7EKp_9HAlgY_ppxH7Ox-DIMb7ywFe_DaLl7b4rW999qa0vTm4cfzdsD2d8svcwvAFyCXq7jD8XGk_8j-BL-fspc</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Sherrill, Gary C.</creator><creator>Esckilsen, Scott</creator><creator>Hudson, Joshua</creator><creator>Kochar, Bharati</creator><creator>Herfarth, Hans H.</creator><creator>Barnes, Edward L.</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9894-8796</orcidid></search><sort><creationdate>20221101</creationdate><title>Relationship Between Stages of Ileal Pouch-Anal Anastomosis, Timing of Restoration of Fecal Continuity, and Pouchitis</title><author>Sherrill, Gary C. ; Esckilsen, Scott ; Hudson, Joshua ; Kochar, Bharati ; Herfarth, Hans H. ; Barnes, Edward L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-d0585c91841cc3c840834962e3095a208f31decceef7eff9beca14a6db9020143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Analysis</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Biochemistry</topic><topic>Cholangitis</topic><topic>Colitis, Ulcerative - complications</topic><topic>Colitis, Ulcerative - surgery</topic><topic>Electronic health records</topic><topic>Feces</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Inflammatory bowel disease</topic><topic>Medical colleges</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Microbiota</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Pouchitis - etiology</topic><topic>Proctocolectomy, Restorative - adverse effects</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Transplant Surgery</topic><topic>Ulcerative colitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sherrill, Gary C.</creatorcontrib><creatorcontrib>Esckilsen, Scott</creatorcontrib><creatorcontrib>Hudson, Joshua</creatorcontrib><creatorcontrib>Kochar, Bharati</creatorcontrib><creatorcontrib>Herfarth, Hans H.</creatorcontrib><creatorcontrib>Barnes, Edward L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sherrill, Gary C.</au><au>Esckilsen, Scott</au><au>Hudson, Joshua</au><au>Kochar, Bharati</au><au>Herfarth, Hans H.</au><au>Barnes, Edward L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relationship Between Stages of Ileal Pouch-Anal Anastomosis, Timing of Restoration of Fecal Continuity, and Pouchitis</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2022-11-01</date><risdate>2022</risdate><volume>67</volume><issue>11</issue><spage>5220</spage><epage>5226</epage><pages>5220-5226</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><abstract>Background
The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis.
Aims
We aimed to investigate whether a shorter period between pouch creation and restoration of fecal flow through an IPAA was associated with an increased risk of development of pouchitis within the first 2 years after IPAA.
Methods
We performed a retrospective cohort study evaluating patients undergoing colectomy with IPAA for UC between January 1, 2004 and December 31, 2016. We used Kaplan–Meier testing and Cox Proportional Hazards Modeling to evaluate the relationship between the time between restoration of fecal continuity and time to subsequent development of pouchitis, adjusting for other clinical and demographic factors.
Results
We identified 624 patients who underwent proctocolectomy with IPAA for UC, of whom 246 (39%) developed pouchitis within the first 2 years after IPAA. There was no difference when comparing the median time to restoration of continuity among those patients who developed pouchitis and those who did not (49 days vs. 49 days,
p
= 0.85) or in multivariable analysis. Primary sclerosing cholangitis (Hazard Ratio [HR] 2.14, 95% CI 1.12–4.08), family history of inflammatory bowel disease (HR 1.49, 95% CI 1.08–2.06), and delayed pouch creation (HR 0.75, 95% CI 0.57–1.00) were significantly associated with time to development of pouchitis.
Conclusion
Although a staged approach to IPAA may have benefits in the surgical management of UC, the timing interval between pouch creation and restoration of continuity did not impact the subsequent development of early pouchitis in this cohort.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35246803</pmid><doi>10.1007/s10620-022-07440-9</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-9894-8796</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Analysis Anastomosis, Surgical - adverse effects Biochemistry Cholangitis Colitis, Ulcerative - complications Colitis, Ulcerative - surgery Electronic health records Feces Gastroenterology Hepatology Humans Inflammatory bowel disease Medical colleges Medical research Medicine Medicine & Public Health Medicine, Experimental Microbiota Oncology Original Article Ostomy Patients Pouchitis - etiology Proctocolectomy, Restorative - adverse effects Retrospective Studies Surgery Transplant Surgery Ulcerative colitis |
| title | Relationship Between Stages of Ileal Pouch-Anal Anastomosis, Timing of Restoration of Fecal Continuity, and Pouchitis |
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