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P271. Management of patients with ulcerative colitis after proctocolectomy: Pouchitis is a frequent complication, sometimes with the need for biological therapy

T. Molnar, K. Farkas, F. Nagy, Z. Szepes, T. Wittmann

First Department of Medicine, University of Szeged, Szeged, Hungary

Introduction: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) represents the most common and potentially curative surgical procedure for intractable ulcerative colitis (UC) since 1978, although up to 50% of the patients undergoing surgery will develop pouchitis.

The aim of this study was to evaluate the frequency of pouchitis in our UC patients who had undergone IPAA and to determine risk factors for the development of simple or refractory pouchitis. We also assessed the efficacy of infliximab in refractory pouchitis.

Patients and Methods: The outcome of 46 UC patients undergoing colectomy was evaluated retrospectively. The average follow-up period was 3.3 years. Pouchitis was defined as Pouchitis Disease Activity Index >7 points. Quality of life before and after colectomy, body weight, disease duration at the time of surgery, the number of in and outpatient visits, surgical interventions because of postoperative complications, and the number of medication used before and after IPAA operation was compared between patients who did and did not develop pouchitis. Demographic, clinical and therapeutic parameters were compared between patients who did and did not develop pouchitis and between those with pouchitis responding or being refractory to the conservative therapy.

Results: 40% of the patients developed pouchitis. Significant differences were revealed in the quality of life, the need for hospitalizations, the number of the surgical interventions and the number of medications after surgery between IPAA patients with and without pouchitis. Six patients received infliximab therapy due to the therapy-refractory condition. Complete and long-term remission was achieved in all cases after a median follow up of 19.8 months. The average times between the occurrences of pouchitis in the refractory and non refractory groups were 3.28 and 1.69 years, respectively. Extraintestinal manifestation and non smoking was characteristic for refractory pouchitis.

Discussion: Pouchitis developed in 40% of our patients undergoing IPAA. The development of pouchitis seems to be predisposed by frequent preoperative hospitalization. 17% of the patients with pouchitis required biological therapy. The earlier development of pouchitis seems to be a prognostic factor for the unsuccessful conservative treatment and the need for biological therapy. Infliximab may be highly effective in refractory pouchitis.