Different Natural History of Ulcerative Colitis (UC) in Hispanic and Caucasian Patients with Ileal Pouch-Anal Anastomosis (IPAA)

Abstract

Purpose: Inflammatory bowel disease is becoming increasingly recognized in ethnic and racial minorities. IPAA has become the treatment of choice for patients with UC requiring surgery. Few studies have characterized UC and pouch outcomes in the Hispanic American population. The aim of the study was to characterize natural history and outcome of IPAA in a Hispanic population. Methods: Hispanic ethnicity was designated by self-report and the Hispanic patients with UC and IPAA were identified from the prospectively maintained pouch database. Demographics, clinical characteristics and pouch outcomes in Hispanic population were compared to those in a random sample of Caucasian patients (1:2 ratio). Exclusion criteria were patients with a preoperative diagnosis of Crohn's disease, indeterminate colitis, or familial adenomatous polyposis, and patients of other ethnic groups. Results: 33 Hispanic patients with IPAA were identified. Gender distribution, family history of IBD, smoking history, preoperative immunomodulator use, extent of UC, toxic megacolon or fulminant colitis, pouch configuration, stage of pouch, presence of extraintestinal manifestation, autoimmune disorders, primary sclerosing cholangitis, or significant comorbidities were similar between the two groups. Current pouch conditions including normal pouch, irritable pouch syndrome, acute pouchitis, chronic pouchitis, cuffitis, surgical complications, and anismus were also similar. However, when compared with Caucasian controls (n=66), Hispanic patients were younger at UC diagnosis and at colectomy, and they were more likely to have colectomy for dysplasia. The interval between diagnosis and colectomy was comparable. No Hispanic patients received biologic agents for UC before colectomy or pouch disease while 10.3% and 11.8% of Caucasian patients had biologics for underlying UC or for pouch diseases, respectively (Table). Conclusion: The natural history of UC differed between the two ethnic groups before colectomy, but similar after colectomy and IPAA. Biosocioeconomical factors may lead to these differences, which warrants further investigation.Table 1: Comparison of clinical characteristics between Hispanic and caucasian populations