POUCHITIS FOLLOWING PELVIC POUCH OPERATION FOR ULCERATIVE-COLITIS - INCIDENCE, CUMULATIVE RISK, AND RISK-FACTORS

AIM: This study was undertaken to assess the risk for pouchitis in pat ients with ulcerative colitis who underwent surgery with colectomy, re storative pelvic pouch, and ileoanal anastomosis and to evaluate possi ble factors predictive for pouchitis development. PATIENTS AND METHODS : All patients receiving a pelvic pouch because of ulcerative colitis at Huddinge University Hospital between 1980 and 1993 (n = 149; 89 men ) were prospectively evaluated for symptoms suggestive of pouchitis. D iagnosis of pouchitis was based on occurrence of certain symptoms in c ombination with endoscopic findings. Pouchitis was divided into mild a nd severe, and the time span until the first attack of mild or severe pouchitis was calculated for each patient. RESULTS: Median follow-up t ime was 54 (5-152) months. The absolute cumulative risk of developing mild pouchitis was 21, 26, and 39 percent at 6, 12, and 48 months, res pectively. The corresponding cumulative risk of developing severe pouc hitis was 9, 11, and 14 percent, respectively. Risk for both groups to gether was 51 percent at 48 months. The occurrence of pouchitis, calcu lated at six-month intervals after closure of the loop ileostomy, was highest (23.1 percent) during the first six months. Incidence during t he next six-month period was 11.4 percent and then only 3.1 percent th ereafter. Thirty-two patients (21.5 percent) had chronic continuous sy mptoms requiring long-term metronidazole treatment, and 14 (9.4 percen t) of those had chronic severe pouchitis. In two patients, removal of the pouch and permanent ileostomy became necessary. Extracolonic manif estations and early onset of ulcerative colitis mere predictive factor s for developing pouchitis. Former smoking seemed to be a protective f actor. CONCLUSION: The risk for pouchitis was highest during the initi al six-month period. Cumulative risk leveled off after two years but w as substantial (51 percent) at four years. Less than 10 percent of pat ients had severe, chronic pouchitis, and only two patients (1.3 percen t) had their pouches removed.