P0718 - Disease Extension in Patients With Limited Ulcerative Colitis at Diagnosis Is Not Associated with Increased Risk of Pouchitis in the First 2 Years After Ileal Pouch-anal Anastomosis

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Sydney Power, MD

University of North Carolina
Chapel Hill, NC

Sydney Power, MD¹, Michael Dunn, BS², Scott Esckilsen, MD³, Hans Herfarth, MD, PhD³, Edward Barnes, MD, MPH, FACG³
¹University of North Carolina, Chapel Hill, NC; ²University of North Carolina School of Medicine, Chapel Hill, NC; ³University of North Carolina at Chapel Hill, Chapel Hill, NC

Introduction: Clinical predictors for the development of pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) remain limited. Disease extension in patients with limited UC at diagnosis has been associated with a worse prognosis including high risk of colectomy. The objective of this study was to evaluate disease extension as a risk factor for pouchitis and chronic inflammatory conditions of the pouch.

Methods: We performed a retrospective cohort study to evaluate the relationship between disease extension from proctitis or left-sided colitis on colonoscopy at diagnosis to extensive colitis prior to colectomy and the subsequent development of inflammatory conditions of the pouch. We used Chi-square and Kaplan-Meier testing as well as multivariable analysis to control for potential confounders.

Results: Among 749 patients, 111 (15%) demonstrated a change to extensive colitis prior to colectomy (original extent: 15% proctitis, 85% left-sided, Table 1). The median time to extension was 36 months, IQR 12-108. There was no significant difference in the proportion of patients developing pouchitis among those patients who experienced disease extension to those who did not (41% vs. 37%, P=0.504) or when comparing those who experienced disease extension to those who had extensive disease at diagnosis (41% vs. 35%, P=0.248). In a multivariable model, there was no association with disease extension and subsequent development of pouchitis (aOR 1.09, 95% CI 0.71-1.67). However, other well-established factors demonstrated an increased odds of developing pouchitis, including family history of IBD (aOR 1.81, 95% CI 1.22-2.67). In Kaplan-Meier testing, there was no significant difference in time to development of pouchitis (P=0.205, Figure 1). Disease extension was also not associated with subsequent development of chronic pouchitis (15% disease extension vs. 15% no extension, P=0.981) or Crohn’s-like disease of the pouch (8% disease extension vs. 16% no extension, P=0.091).

Discussion: A recent change in phenotype to extensive disease is not associated with the development for pouchitis in the first 2 years after IPAA.

Figure: Figure 1. Time to development of pouchitis, comparison of patients with disease extension and those without disease extension

	No disease extension prior to colectomy for ulcerative colitis n=638		Disease extension prior to colectomy for ulcerative colitis n=111		p-value
	median	IQR	median	IQR
Age at surgery	40.8	29-54	40.4	30-52	0.609
	n	%	n	%
Male sex	342	54	56	50	0.539
Race White Non-White	469 155	25 75	34 76	31 69	0.180
Hispanic	13	2	4	4	0.300
Family history of inflammatory bowel disease	102	17	20	19	0.609
Indication for surgery Medically-refractory colitis Dysplasia or cancer Other indication	. 489 87 62	77 14 10	98 8 5	88 7 5	0.023
Disease extent prior to surgerya Proctitis Left-sided colitis Extensive colitis	31 201 363	5 34 61	0 0 111	0 0 100	< 0.001
Stage of IPAA surgery I II Modified II III	109 221 220 87	17 35 35 14	13 33 40 25	12 30 36 23	0.060
Primary Sclerosing Cholangitis	23	4	1	1	0.136
Pathology at the time of colectomy Ileitis Granuloma Transmural inflammation	114 26 42	18 4 7	13 6 5	12 5 5	0.112 0.520 0.407

Table: Table 1. Demographic and clinical characteristics of patients undergoing ileal pouch-anal anastomosis, stratified by disease extension prior to surgery

Disclosures:

Sydney Power indicated no relevant financial relationships.

Michael Dunn indicated no relevant financial relationships.

Scott Esckilsen indicated no relevant financial relationships.

Hans Herfarth: BMS – Consultant. EXE-GI – Consultant. Fresenius Kabi – Consultant. Galapagos – Consultant. Gilead – Consultant. Janssen – Consultant. NovoNordisk – Grant/Research Support. Pfizer – Grant/Research Support. Ventyx – Consultant.

Edward Barnes: AbbVie, Inc. – Consultant. Bristol-Meyers Squibb – Consultant. Eli Lilly – Consultant. Target RWE – Consultant.

Sydney Power, MD¹, Michael Dunn, BS², Scott Esckilsen, MD³, Hans Herfarth, MD, PhD³, Edward Barnes, MD, MPH, FACG³. P0718 - Disease Extension in Patients With Limited Ulcerative Colitis at Diagnosis Is Not Associated with Increased Risk of Pouchitis in the First 2 Years After Ileal Pouch-anal Anastomosis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.