BACKGROUND:

Pouchitis is the most frequent complication after IPAA in patients with ulcerative colitis. Antibiotics represent the mainstay of treatment, suggesting a crucial role of dysbiosis in the pathogenesis of this condition. Anti-tumor necrosis factor agents have been shown to adversely impact the gut microbiome and local host immunity.

OBJECTIVE:

The aim of this study is to assess the effect of prior exposure to biologics on the development of pouchitis in patients who have ulcerative colitis.

DESIGN:

This is a retrospective case-control study.

SETTINGS:

This study was conducted at a tertiary-care IBD center.

PATIENTS:

Consecutive patients with ulcerative colitis who underwent restorative proctocolectomy between 2000 and 2010 were included.

MAIN OUTCOME MEASURES:

The primary outcome measured was the incidence of pouchitis.

RESULTS:

Four hundred seventeen patients with ulcerative colitis who underwent IPAA were included. The incidence of pouchitis was 40.4%. There were no differences in patient demographics, disease-specific factors, surgical approach, and short-term postoperative complications between patients who developed pouchitis compared to those that did not. Patients exposed to anti-tumor necrosis factor agents or preoperative steroids were significantly more likely to develop pouchitis (anti-tumor necrosis factor: 47.9% vs 36.5%, p= 0.027; steroids: 41.7% vs 23.3%, p= 0.048). However, on multivariable analysis, only anti-tumor necrosis factor therapy was an independent predictor for pouchitis (p= 0.05). Pouchitis was not associated with adverse long-term outcomes.

LIMITATIONS:

The retrospective design was a limitation of this study.

CONCLUSION:

In a large cohort of patients undergoing IPAA for ulcerative colitis with at least a 5-year follow-up, anti-tumor necrosis factor exposure was the only independent risk factor for the development of pouchitis. These agents may “precondition” the pouch to develop pouchitis through alterations in the microbiome and/or local host immunity of the terminal ileum. See Video Abstract at https://links. lww. com/DCR/B19.