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P313 Time to second pouchitis episode in a Dutch academic cohort

D.C. de Jong1, K. Wasmann2, C. Buskens2, W. Bemelman2, M. Löwenberg1, K. Gecse1, C. Ponsioen1, G. D’Haens1, R. Hompes2, M. Duijvestein1

1Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands, 2Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands

Background

Pouchitis is the most frequent long-term complication after proctocolectomy and ileal-pouch anal anastomosis (IPAA) in patients with ulcerative colitis (UC), with a long-term cumulative incidence of 24–59%.1,2 Pouchitis creates an important burden of disease with symptoms including urgency, increased stool frequency, mucinous and/or bloody stools and abdominal cramps. The majority of patients (65%) with an episode of acute pouchitis will experience at least one recurrence.3,4 However, these studies do not specifically address how soon these relapses will occur. The aim of this study is to determine the time until the second episode of pouchitis occurs.

Methods

In total, 353 consecutive UC patients who underwent RPC and IPAA from March 1999 until January 2018 were retrospectively reviewed. Information on the timing of pouchitis was retrieved from the electronic patient database. Baseline was defined as the date when the pouch was put in functional use. Pouchitis had to be objectified by endoscopic assessment at least once at one of the episodes. Patients with isolated ileitis of the afferent limb or cuffitis without pouchitis were excluded.

Results

91 (26%) patients received at least one endoscopic assessment of the pouch that showed pouchitis. Twenty-seven patients (30%) experienced only one episode of pouchitis, 42 patients (46%) had more than one episode and 22 patients (24%) went on to develop a chronic phenotype of pouchitis. The median time until the first episode of pouchitis was 388 days [IQR: 189–1049]. After excluding patients with only a single pouchitis episode and 9 chronic pouchitis patients who were treatment refractory or dependent after the first episode, 55 (60%) patients were assessed for the date of the second episode. Median time from the first episode until the second episode was 433 days [IQR: 272 – 1203] (Figure 1).

Conclusion

In this cohort of UC-IPAA patients, 70% of all pouchitis patients developed more than one episode of pouchitis or progressed into a chronic phenotype. The majority of second episodes of pouchitis occur within approximately 3 years of the first episode.