P0256 Histologically-proven isolated cuffitis and quality of life among patients with ileoanal pouch

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Abstract Background Patients with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA) may develop inflammation of the ileal pouch (pouchitis), rectal cuff (cuffitis), or both. We aimed to evaluate how isolated cuffitis impacts patients' quality of life (QoL). Methods In a comprehensive pouch clinic at a tertiary referral center (Rabin Medical Center), consenting patients were followed prospectively, with routine clinical, laboratory, endoscopic, and QoL evaluations. Patients undergoing IPAA due to UC and having ≥1 cuff biopsy during follow-up were included. Patients with isolated cuffitis (cuff inflammation but no pouch inflammation) were compared to patients with isolated pouchitis (inflammation of the pouch with a normal cuff). Pouch endoscopy findings were defined based on the Pouchitis Disease Activity Index (PDAI) endoscopic and histologic subscores. Cuff endoscopy findings were defined based on Mayo endoscopic subscore and NANCY histological index. Cuffitis was defined as evidence of moderate-to-severe histologic inflammation (NANCY score 3-4). Results The cohort included 116 patients (median age 50 years, IQR 42-64; 60% females, n=68) who underwent 250 endoscopies (median 2, range 1-3). Isolated cuffitis (Mayo≥2) was diagnosed in 7 endoscopies, and isolated pouchitis (PDAI>2) in 33. Histologically, isolated cuffitis was detected in 39 biopsies, and isolated pouchitis in 72 biopsies. Patients with isolated cuffitis had higher body mass index (27 [23–29] vs. 23 [21–27], p=.03). Inflammatory markers, including C-reactive protein (0.61 [0.32–1.27] vs. 0.64 [0.31–1.03], p=.98) and fecal calprotectin (135.5 [53.25–347.5] vs. 276.0 [131.0–553.0], p=.21), were similar. Both groups had comparable daily bowel movements (BMs); 39% of patients with isolated cuffitis vs. 42% of those with isolated pouchitis had >10 BM/day (p=.79). Bristol stool scale scores 6-7 were reported in 94% of patients with isolated cuffitis compared to 76% with pouchitis (p=.04). Both groups had similar PDAI clinical sub-scores (p=.98). Patients with isolated cuffitis were more likely to report overall (22% vs. 7%, p=.08) and current (31% vs. 16%, p=.13) poor well-being. QoL scores were comparable: median Short Inflammatory Bowel Disease Questionnaire (SIBDQ) 46.5 vs. 50.5, (p=.53) and IBD-Control score of 10.0 vs. 7.0, (p=.6). Conclusion Cuff histology reveals higher rates of inflammation than endoscopy alone. Patients with histologically-proven isolated cuffitis and a normal pouch experience a negative impact on QoL as those with an inflamed pouch only. These findings suggest that greater attention to identifying cuffitis and effective management are required.