Childhood Environmental Exposures as Risk Factors for Pouchitis in Patients with Ulcerative Colitis

Abstract

Purpose: Pouchitis is the most common long-term complication of ileal pouch-anal anastomosis(IPAA). Although a significant association between childhood environmental factors and UC has been documented, there are no studies evaluating a possible relationship between these factors and pouchitis. The aim of this study is to assess whether childhood environmental exposures are risk factors for developing pouchitis in patients with UC after IPAA. Methods: 141 patients with UC were identified from a database of patients recruited for the IBD Genetics Consortium between 1995 and 2008. Patients were from the community or the University of Puerto Rico Center for Inflammatory Bowel Diseases clinics. 88 were followed in our clinics and had a record with documented disease evolution and treatment. Patients had consented previously for the release of information for research purposes. Demographic characteristics and treatment data was gathered retrospectively; subjects were assigned to Group A: no surgery (n=35), B: surgery other than IPAA (n=6),and C: IPAA (n=47). We focused on patients with IPAA who also participated in a dysplasia surveillance protocol, where interval pouchoscopies with biopsies were performed. Recorded childhood environmental factors were urban vs. rural living, running water, toilet inside home, public sewer, breast feeding history, socioeconomic status and education. Presence of pouchitis using histological criteria was determined by an expert pathologist. An individual pouchitis rate was determined dividing number of pouchitis by number of pouchoscopies. Results: No correlation of statistical significance was found between individual exposures (not having running water p=0.66, not having a toilet at home p=0.90, not having public sewer service p=0.79) and recurrent pouchitis (rate >0.5). All three variables combined had no statistical significance (p=0.79). Breast feeding, education, and socioeconomic status did not significantly change this outcome either. However, 21/29 (72%) patients with pouchitis were not exposed to environmental risk factors. Conclusion: Although no significance was found between exposure to risk factors during childhood and recurrent pouchitis, lack of exposure to risks was prevalent in pouchitis. This finding is compatible with the hygiene hypothesis suggested in previous studies. Supported by the UPR SoM Endowed Health Services Research Center Grants 5S21MD000242 and 5S21MD000138, NCMHD-NIH;Grant 5P20RR011126(NCRR,NIH);and NIDDK U01 DK62413 (IBDGRC).