P035 ADJUNCT PHARMACOTHERAPY USE FOR POUCH-RELATED SYMPTOMS IN PATIENTS WITH ILEAL POUCH-ANAL ANASTOMOSIS

Abstract

Abstract Background For patients with recalcitrant ulcerative colitis or indeterminate colitis, surgical intervention with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become the standard of therapy. The most common complication after IPAA is pouchitis, which may manifest with pouch related symptoms (PRS) such as increased bowel frequency, abdominal pain, pelvic pain, urgency, or incontinence, necessitating use of adjunctive pharmacotherapies for symptom control. We evaluated the prevalence of opioid-, NSAID-, and probiotic-use among IPAA patients with and without PRS. Methods Utilizing patient questionnaires from the IBD Partners database cohort of patients with IPAA, we examined baseline characteristics, antibiotic and biologic use, adjunct pharmacotherapy use, and patient reported outcomes (PROs) including bowel frequency, urgency of defecation, and general well-being. We used specific Patient-Reported Outcome Measurement Information System (PROMIS) measures (measured in T-scores) to assess abdominal pain and depression. Bivariate analysis of baseline demographics and medication use patterns was performed to compare IPAA patients with PRS and without PRS. Among patients with PRS, PROs were compared among opioid, NSAID, and probiotic users. Results We identified 363 patients with IPAA patients in the IBD Partners database, and 266 (73%) reported PRS within 6 months of completing their last survey. In comparison to those without PRS, patients with significant PRS had a shorter time since diagnosis of IBD (P = 0.015), higher prevalence of antibiotic use (P < 0.05), higher rectal steroid use (P = 0.003), and more prevalent adalimumab use (P = 0.041). Among patients with PRS, there were no significant differences in PROs based on NSAID or probiotic usage. However, opiate users with PRS noted increased bowel frequency, urgency of defecation, poor general well-being, abdominal pain, and depression (P < 0.05 for all variables). Conclusion Among IBD patients with IPAA with PRS, the use of NSAIDS and probiotics was not associated with differences in PROs. Opioid use was associated with higher burden of PRS, but further studies will be required to elucidate association or causality.