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Greater Peripouch Fat Area on CT Image Is Associated with Chronic Pouchitis and Pouch Failure in Inflammatory Bowel
Xian-Hua Gao1,2, Guan-Yu Yu2, Freeha Khan3
1Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Background:
The causes of chronic antibiotic refractory pouchitis (CARP) and pouch failure in inflammatory bowel disease (IBD) patients remain unknown. Our previous small study showed peripouch fat area measured by MRI was associated with pouchitis.
Aims:
To explore the relationship between peripouch fat area on CT imaging and pouch outcomes.
Methods:
This is a historical cohort study. Demographic, clinical, and radiographic data of IBD patients with abdominal CT scans after pouch surgery between 2002 and 2017 were collected. Peripouch fat areas and mesenteric peripouch fat areas were measured on CT images at the middle pouch level.
Results:
A total of 435 IBD patients were included. Patients with higher peripouch fat areas had a higher prevalence of CARP. Univariate analyses demonstrated that long duration of the pouch, high weight or body mass index, the presence of primary sclerosing cholangitis or other autoimmune disorders, and greater peripouch fat area or mesenteric peripouch fat area were risk factors for CARP. Multivariable analyses demonstrated that the presence of primary sclerosing cholangitis or autoimmuned disorders, and greater peripouch fat area (odds ratio [OR] 1.031; 95% confidence interval [CI] 1.016-1.047, P < 0.001) or mesenteric peripouch fat area were independent risk factors for CARP. Of the 435 patients, 139 (32.0%) had two or more CT scans. Multivariable Cox proportional hazard analyses showed that "peripouch fat area increase ≥ 15%" (OR 3.808, 95%CI 1.703-8.517, P = 0.001) was an independent predictor of pouch failure.
Conclusions:
A great peripouch fat area measured on CT image is associated with a higher prevalence of CARP, and the accumulation of peripouch fat is a risk factor for pouch failure. The assessment of peripouch fat may be used to monitor the disease course of the ileal pouch.
Insights
Increased peripouch fat area on CT scans is linked to chronic antibiotic refractory pouchitis (CARP) and pouch failure in inflammatory bowel disease (IBD) patients. Monitoring peripouch fat may help manage ileal pouch disease.
Area of Science:
- Gastroenterology
- Radiology
- Inflammatory Bowel Disease Research
Background:
- The etiology of chronic antibiotic refractory pouchitis (CARP) and pouch failure in inflammatory bowel disease (IBD) patients is not well understood.
- Previous research indicated a potential association between peripouch fat area, measured via MRI, and the incidence of pouchitis.
Purpose of the Study:
- To investigate the correlation between peripouch fat area, as assessed by CT imaging, and pouch outcomes in IBD patients.
- To identify imaging-based predictors for CARP and pouch failure.
Main Methods:
- A historical cohort study design was employed, analyzing data from IBD patients who underwent pouch surgery and subsequent abdominal CT scans between 2002 and 2017.
- Peripouch fat area and mesenteric peripouch fat area were quantified at the middle pouch level on CT images.
- Demographic, clinical, and radiographic data were collected for 435 IBD patients.
Main Results:
- Higher peripouch fat areas were associated with an increased prevalence of CARP.
- Independent risk factors for CARP included primary sclerosing cholangitis or autoimmune disorders, and greater peripouch or mesenteric peripouch fat area.
- An increase in peripouch fat area of ≥15% emerged as an independent predictor of pouch failure (OR 3.808, P=0.001).
Conclusions:
- A substantial peripouch fat area on CT imaging correlates with a higher prevalence of CARP.
- Peripouch fat accumulation is identified as a risk factor for pouch failure.
- CT-based assessment of peripouch fat may serve as a valuable tool for monitoring the disease progression in ileal pouch patients.
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