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The Cumulative Incidence of Pouchitis in Pediatric Patients With Ulcerative Colitis
Ellen Cowherd1, Matthew D Egberg2,3,4, Michael D Kappelman2,3,4
1Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Insights
Pouchitis affects over half of pediatric ulcerative colitis patients within two years of ileal pouch-anal anastomosis (IPAA) surgery. This condition significantly increases healthcare utilization and costs for these young patients.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease Research
Background:
- Pediatric ulcerative colitis (UC) often necessitates proctocolectomy with ileal pouch-anal anastomosis (IPAA) due to refractory disease.
- Pouchitis is a common complication following IPAA, impacting patient quality of life and healthcare resource utilization.
Purpose of the Study:
- To determine the incidence, risk factors, and clinical burden of pouchitis in pediatric UC patients within the first two years after IPAA.
- To provide data that can inform early intervention strategies for pouchitis in this vulnerable population.
Main Methods:
- Retrospective analysis of a large claims database (IQVIA Legacy PharMetrics) from 2007-2015.
- Identification of pediatric UC patients who underwent proctocolectomy with IPAA using ICD and CPT codes.
- Statistical comparison of outcomes between patients with and without pouchitis using t-tests, Wilcoxon rank sum, and chi-square tests.
Main Results:
- The cumulative incidence of pouchitis within two years post-IPAA was 54% among 68 identified pediatric UC patients.
- Pouchitis patients had significantly more outpatient visits (21.8 vs 10.2) and higher hospitalization rates (46% vs 23%).
- Mean total healthcare costs were substantially higher for patients with pouchitis in both year 1 ($27,489 vs $8,032) and year 2 ($27,699 vs $6,058).
Conclusions:
- The high incidence of pouchitis in pediatric UC patients undergoing IPAA is confirmed, aligning with previous single-center findings.
- Early identification of risk factors for pouchitis is crucial for optimizing treatment and improving outcomes.
- Pouchitis represents a significant clinical and economic burden for pediatric patients with UC post-IPAA.
Background:
Despite highly effective therapies, many children develop medically refractory ulcerative colitis (UC) and undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). We sought to determine the incidence, risk, and burden of pouchitis in the first 2 years following the final stage of IPAA in pediatric UC patients.
Methods:
Within the IQVIA Legacy PharMetrics Adjudicated Claims Database, we identified pediatric patients with UC who underwent proctocolectomy with IPAA between January 1, 2007, and June 30, 2015. We utilized International Classification of Diseases-Ninth Revision-Clinical Modification or International Classification of Diseases-Tenth Revision-Clinical Modification codes to identify patients with UC and Current Procedural Terminology codes to identify colectomy and IPAA. Continuous variables were compared using t tests and Wilcoxon rank sum testing, while categorical variables were compared using chi-square testing.
Results:
A total of 68 patients with an IPAA were identified. In the first 2 years following IPAA, the cumulative incidence of pouchitis was 54%. Patients with pouchitis required more outpatient visits in the first 2 years after IPAA (mean 21.8 vs 10.2; P = .006) and were more likely to be hospitalized compared with patients without pouchitis (46% vs 23%; P = .045). Patients with pouchitis also demonstrated higher mean total costs in year 1 and year 2 ($27 489 vs $8032 [P = .001] and $27 699 vs $6058 [P = .003], respectively).
Conclusions:
Our findings confirm the high incidence of pouchitis demonstrated in earlier single-center studies of pediatric patients undergoing proctocolectomy with IPAA for UC. Identification of risk factors for pouchitis would be useful to optimize early intervention.
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