Endoscopic Response on Pouchoscopy Linked to Reduced Risk of Pouchitis in Crohn’s Disease

Patients with ulcerative colitis (UC) who undergo ileal pouch-anal anastomosis surgery have up to a 15% risk of subsequently developing Crohn’s disease-like pouch inflammation (CDLPI). We have been aware of the risk of acute or chronic pouchitis, which typically can be treated with antibiotics. However, CDLPI most often requires escalation to advanced inflammatory bowel disease therapy. When offering colectomy as a treatment option for our patients with UC, it would be helpful to provide risks of future disease to help them in making that decision, or if surgery becomes inevitable, what they may have to face in the future.

In this single-center retrospective study of 110 adult patients with CDLPI in clinical remission at the time of pouchoscopy, the authors evaluated the subsequent risks of pouchitis and a change in biologic therapy after follow-up pouchoscopy. CDLPI was defined as the presence of >10 cm of inflammation in the pre-pouch ileum, strictures, and/or fistula occurring more than 12 months after ileostomy closure.

Based on Pouchitis Disease Activity Index scores, pouchitis occurred in 69 patients (63%), and 50 (46%) required a change in therapy. Those who had achieved endoscopic response or remission had a significantly lower risk of subsequent pouchitis or change in treatment. More specifically, there was no difference between endoscopic remission and endoscopic response regarding these outcomes, or in the time to develop pouchitis or change therapy.