P206 Demographic data and therapy before proctocolectomy with ileal pouch-anal anastomosis are associated with long-term pouch outcomes: A report from the epi-IIRN
J. Ollech1, S. Harel2, K. Yadgar1, N. Asayag2, A. Cahan3, N. Lederman4, E. Matz5, R. Balicer6, B. Feldman6, I. Brufman6, Z. Haklai7, D. Turner2, I. Dotan1, epi-IIRN
1Department of Gastroenterology, Rabin Medical Center, Petach Tikva, Israel, 2Institute of Pediatric Gastroenterology and Nutrition, Shaare Tzedek Medical Center, Jerusalem, Israel, 3Maccabi Health Services, Tel-Aviv, Israel, 4Medical Division, Meuhedet Sick Fund, Tel-Aviv, Israel, 5Leumit Health Fund, Leumit Health Fund, Tel-Aviv, Israel, 6Clalit Health Services, Clalit Research Institute, Tel-Aviv, Israel, 7Ministry of Health, Jerusalem, Israel
Up to 25% of patients with ulcerative colitis (UC) may undergo restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Pouchitis may occur in 50–70% of patients, and ~30% may develop chronic pouchitis (CP) or Crohn’s-like disease of the pouch (CLDP). We aimed to identify predictors for the development of CP or CLDP during a long follow-up period.
Patients followed prospectively at the pouch clinic at Rabin Medical Center, were cross-referenced with data from the validated epiIIRN cohort which includes all IBD patients in Israel (
We included 182 patients (55% females; median age at IPAA: 32 years (IQR 23–45); median disease duration until pouch surgery 6 years (3–11); two-staged surgery 69%). The median follow up time was 14 years (IQR 7–22). Before surgery, 37% of patients had been exposed to immunomodulators (either thiopurines or methotrexate), 24% were exposed to anti-TNF therapy and 5% were previously treated with vedolizumab. An unfavourable pouch phenotype was noted in 48% of patients. On multivariate logistic regression, anti-TNF therapy and older age at pouch surgery were associated with decreased odds of an unfavourable pouch outcome (OR 0.3 95% CI 0.11–0.69,
Therapy of UC with an anti-TNF and older age were associated with a favourable pouch outcome. These may be surrogates for patients with longer follow up as well as indication for IPAA. Such factors should be taken into consideration in clinical decision making.