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PREDICTIVE FACTORS FOR CHRONIC RELAPSING POUCHITIS FOLLOWING RESTORATIVE PROCTOCOLECTOMY FOR ULCERATIVE COLITIS
Imerio Angriman
2, Marta Da Broi
*1, Cesare Ruffolo
1, Luca Saadeh
1, Melania Scarpa
3, Andromachi Kotsafti
3, Astghik Stepanyan
1, Brigida Barberio
1, Fabiana Zingone
3, Gaya Spolverato
2, Ignazio Castagliuolo
2, Edoardo V. Savarino
2, Marco Scarpa
21Chirurgia Generale 3, Azienda Ospedale Universita Padova, Padova, Veneto, Italy; 2Universita degli Studi di Padova, Padova, Veneto, Italy; 3Istituto Oncologico Veneto IRCCS, Padova, Veneto, Italy
Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease often requiring surgical intervention, such as restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA). Pouchitis is a frequent postoperative complication, and it may become chronic or relapsing. This study aims to identify predictors associated with the development of chronic relapsing pouchitis (CRP) in patients undergoing IPAA for UC.
Methods: This single-center retrospective study included 96 patients who underwent RPC with IPAA at Padua Hospital from 2013 to 2024. Demographic, clinical, and postoperative data were collected. Variables such as sex, age at diagnosis and at operation, smoking status, family history of IBD, presence of extraintestinal manifestations, preoperative medical therapy and blood tests, surgery indications, type of surgery, and postoperative complications, were tested to identify possible risk factors for CRP. Univariate and multiple logistic regression models were analyzed.
Results: Among the 96 patients included, 16 developed CRP following IPAA surgery with a median follow-up of 40 months (up to 120 months). Age at surgery was lower in patients with CRP [36 (18-61) vs. 48 (20-76) years. p=0.02]. The presence of EIMs was strongly associated with CRP (37.5% in CRP patients vs. 5% in non-CRP patients, p=0.002), particularly in patients with primary sclerosing cholangitis. Patients with CRP had a higher rate of urgent presentation (25% vs 12,5%, p=0.04). Age at surgery demonstrated a fair predictive capacity (AUC: 0.682, 95% CI: 0.569 - 0.781, p=0.007), suggesting that younger patients are more susceptible to developing CRP. Moreover, survival analysis revealed that these patients had a significantly lower disease-free survival (DFS) with an estimated 2.66-fold increased risk compared to those aged 43 years or older (HR: 2.6581. 95% CI: 1.1835-6.0125, p=0.0180). Similarly, DFS for patients with EIMs was lower (HR: 0.4317, 95% CI: 0.1037-0.9857. p=0.0471). Urgency could also be considered as a predictor of pouchitis onset with an HR: 0.40 (95% CI: 0.098-0.857, p=0.0251). In multivariable logistic regression analysis younger age at surgery (OR: 0.0361, 95% CI: 0.037-0.3536, p=0.043), the presence of EIMs (OR: 43.829, 95% CI: 3,2044-599,4924, p=0.0021) and urgency presentation (OR: 24.75, 95% CI: 2.2934-267.3082, p=0.0082) resulted strongly associated with an increased likelihood of developing CRP.
Conclusions: CRP is a relevant complication in patients with IPAA, negatively impacting quality of life and ileal-pouch survival. Age at surgery, EIMs, and urgency presentation are independent predictors of CRP. Identifying these factors is essential for planning personalized management (i.e., early probiotics administration) and communicating patient prognosis.
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