Document Detail


Risk factors for diseases of ileal pouch-anal anastomosis after restorative proctocolectomy for ulcerative colitis.
MedLine Citation:
PMID:  16431309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Although pouchitis is considered the most common adverse sequela of ileal pouch-anal anastomosis (IPAA), inflammatory and noninflammatory conditions other than pouchitis are increasingly being recognized. The risk factors for these non-pouchitis conditions, including Crohn's disease (CD) of the pouch, cuffitis, and irritable pouch syndrome (IPS), have not been studied. The aim of this study was to assess risk factors for inflammatory and noninflammatory diseases of IPAA in a tertiary care setting. METHODS: The study consisted of 240 consecutive patients who were classified as having healthy pouches (N = 49), pouchitis (N = 61), CD of the pouch (N = 39), cuffitis (N = 41), or IPS (N =50). Demographic and clinical features were assessed to determine risk factors for each of these conditions by using logistic regression analysis. RESULTS: Risk factors remaining in the final logistic regression models were for pouchitis: IPAA indication for dysplasia (odds ratio [OR], 3.89; 95% confidence interval [CI], 1.69-8.98), never having smoked (OR, 5.09; 95% CI, 1.01-25.69), no use of anti-anxiety agents (OR, 5.19; 95% CI, 1.45-18.59), or use of NSAIDs (OR, 3.24; 95% CI, 1.71-6.13); for CD of the pouch: a long duration of IPAA (OR, 1.20; 95% CI, 1.12-1.30) and current smoking (OR, 4.77; 95% CI, 1.39-16.25); for cuffitis: arthralgias (OR, 4.13; 95% CI, 1.91-8.94) and younger age (OR, 1.16; 95% CI, 1.01-1.33); and for IPS: use of antidepressants (OR, 4.17, 95% CI, 1.95-8.92) or anti-anxiety agents (OR, 3.21; 95% CI, 1.34-7.47). CONCLUSIONS: The majority of risk factors for the 4 inflammatory and noninflammatory conditions of IPAA are different, suggesting that each of these diseases has a different etiology and pathogenesis. The identification and modification of these risk factors might help patients and clinicians to make a preoperative decision for IPAA, reduce IPAA-related morbidity, and improve response to treatment.
Authors:
Bo Shen; Victor W Fazio; Feza H Remzi; Aaron Brzezinski; Ana E Bennett; Rocio Lopez; Jeffrey P Hammel; Jean-Paul Achkar; Charles L Bevins; Ian C Lavery; Scott A Strong; Conor P Delaney; Wendy Liu; Marlene L Bambrick; Kerry K Sherman; Bret A Lashner
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  4     ISSN:  1542-3565     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-24     Completed Date:  2006-05-08     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  81-9; quiz 2-3     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology/Hepatology, Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. shenb@ccf.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-Anxiety Agents
Anti-Bacterial Agents
Anti-Inflammatory Agents, Non-Steroidal
Antidepressive Agents
Colitis, Ulcerative / surgery
Colonic Pouches / pathology*
Female
Humans
Inflammation
Male
Pouchitis / classification,  epidemiology*
Proctocolectomy, Restorative / adverse effects*
Risk Factors
Smoking
Grant Support
ID/Acronym/Agency:
R03 DK 067275/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Anxiety Agents; 0/Anti-Bacterial Agents; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antidepressive Agents
Comments/Corrections
Comment In:
Inflamm Bowel Dis. 2007 Jan;13(1):116-7   [PMID:  17206647 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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