P154. Risk factors for colectomy and pouchitis in ulcerative colitis patients with severe flare-up
K. Farkas1, F. Nagy1, Z. Szepes1, A. Bálint1, T. Nyári2, T. Wittmann1, T. Molnár1, 1University of Szeged, First Department of Medicine, Szeged, Hungary, 2University of Szeged, Department of Medical Informatics, Szeged, Hungary
Approximately 30% of patients with relapsing, extensive ulcerative colitis (UC) require surgery. Pouchitis develops in about 50% of the UC patients undergoing colectomy. Finding simple risk factors predisposing to colectomy and the development of postoperative pouchitis could help to optimize therapy or indicate surgery in time in patients with UC. The aim of the present study was to evaluate the frequency of colectomy and postoperative pouchitis and to determine predictive factors of colectomy and pouchitis in our UC patients.
Using our IBD database, we evaluated every hospital admissions of UC patients with acute exacerbation requiring intravenous corticosteroid treatment between 1998 and 2009. Inflammatory laboratory parameters were assessed at every hospitalization of patients undergoing colectomy and in those who avoided surgery. Clinical and demographic data were also compared and statistically analyzed between the two groups. Demographic, clinical and therapeutic parameters were compared between patients who did and did not develop pouchitis after colectomy and between those with pouchitis responding or being refractory to the conservative therapy.
The records of 182 UC patients with a total of 276 hospitalizations because of severe relapse of UC were reviewed. 46 patients underwent colectomy. Pancolitis, low hematocrit level and the need for blood transfusion were significantly more common in the colectomy group (p = 0.004 and p = 0.002). The number of hospitalization, disease duration, and a lower body mass index value also proved to predispose to surgery (p = 0.004, p = 0.049 and p = 0.027). 35 of the 46 colectomized patients underwent ileal pouch-anal anastomosis procedure. 40% of these patients developed pouchitis. Frequent hospital admissions before colectomy, the presence of extraintestinal manifestations and non smoking status were characteristic for refractory pouchitis.
Our results suggest that severe UC patients with pancolitis, anemia, longer disease duration and frequent hospital admissions have a higher likelihood of requiring colectomy. The development of pouchitis seems to be predisposed by frequent hospital admissions before colectomy. Severe, refractory pouchitis was significantly more common in non-smokers and in patients with extraintestinal manifestations.