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Predictors for Pouchitis After Ileal Pouch-Anal Anastomosis for Pediatric-Onset Ulcerative Colitis
Yuhki Koike1, Keiichi Uchida1, Mikihiro Inoue1
1Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Insights
High cumulative steroid doses and elevated neutrophil percentages before surgery predict pouchitis in pediatric ulcerative colitis patients undergoing IPAA. These factors are crucial for identifying at-risk individuals.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Inflammatory Bowel Disease Research
Background:
- Pouchitis is a common complication following ileal pouch-anal anastomosis (IPAA) in pediatric ulcerative colitis (UC).
- Predictive factors for pouchitis in this specific population remain underexplored, necessitating further investigation.
Purpose of the Study:
- To identify preoperative and intraoperative predictors of pouchitis development after IPAA in pediatric UC patients.
- To establish a basis for risk stratification and potential preventative strategies.
Main Methods:
- Retrospective analysis of 54 pediatric UC patients who underwent IPAA between 2000 and 2017.
- Statistical analysis including Cox regression, t-tests, Mann-Whitney U tests, and Kaplan-Meier curves to identify predictors.
- Pouchitis defined as a modified pouchitis disease activity index score of ≥5.
Main Results:
- Pouchitis developed in 31.5% of patients within 5 years of follow-up.
- Independent predictors for pouchitis included a cumulative steroid dose >10,000 mg and a neutrophil percentage >65% before IPAA.
- Patients with neither predictor had no pouchitis, while over 40% with one or both predictors developed pouchitis.
Conclusions:
- Elevated cumulative steroid dose and high preoperative neutrophil percentage are significant predictors of pouchitis in pediatric UC patients.
- These findings can aid in identifying high-risk patients for pouchitis post-IPAA.
Background:
The predictive factors for the development of pouchitis after ileal pouch-anal anastomosis (IPAA) in pediatric-onset ulcerative colitis (UC) have not been well investigated. The present study aimed to determine the predictive factors for the development of pouchitis after IPAA in the pediatric UC population.
Methods:
The data from 54 patients with pediatric-onset UC who underwent IPAA in Mie University Hospital between 2000 and 2017 were retrospectively reviewed. A modified pouchitis disease activity index of ≥5 was defined as pouchitis. Potential preoperative, intraoperative, and postoperative predictors for pouchitis including various demographic and clinical variables were analyzed using Cox regression analysis, Students' t-tests, Mann-Whitney U tests, and Kaplan-Meier curves. The optimal cutoff value for continuous variables was determined using the receiver operating characteristic curve analysis.
Results:
Pouchitis was identified in 17 (31.5%) patients within 5 y of follow-up. In multivariable analysis, the independent predictors for pouchitis were preoperative cumulative steroid dose of >10,000 mg (P = 0.0056) and >65% neutrophils just before IPAA (P = 0.032). Multivariate analysis revealed that the independent predictors of pouchitis were a total steroid dose of >10,000 mg (P = 0.0002) and a neutrophil percentage of >65% (P = 0.0078). No patient for whom both of these independent predictors were negative developed pouchitis, whereas >40% of patients who had one or both predictors developed pouchitis.
Conclusions:
In pediatric patients with UC, the predictive factors for pouchitis development are a greater cumulative total dose of steroids and a greater percentage of neutrophils before IPAA.
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