S1118 Pregnancy, Disease Activity and IBD Medication: This Two-Edged Sword from a Patient Perspective

Abstract

Background: Ileal pouch anal anastomosis (IPAA) is the surgical treatment of choice for ulcerative colitis (UC) patients. The procedure is safe and effective but is also associated with long term complications such as pouch inflammation (pouchitis) reported in up to 60% of patients. The reasons for pouch inflammation are vague and prediction of pouchitis is still impossible. Normal pouch status is usually defined clinically and there is lack of longitudinal studies investigating the processes occurring in a “normal” pouch. Aim: To evaluate the clinical, laboratory, endoscopic and histologic characteristics of normal pouches longitudinally. Methods: UC Patients undergoing IPAA were prospectively followed up at a pouch clinic. Clinical, laboratory, endoscopic and histologic evaluation was performed at least yearly. Normal pouch status was defined at first visit as no previous episodes of pouchitis and pouch disease activity index (based on clinical, endoscopic and histologic scores, maximum 6 points each)<7 for the first two years of follow up without antibiotic or anti inflammatory treatment. Patients were used as their own controls, thus only patients with≥2 follow up visits were included. Results: Out of 167 pouch patients 25 (15%, 12 males, average age 47.4 ±14.6 years) were recruited to the “normal pouch” cohort. Time since surgery was 8±6.3 (range 3-14). Average number of bowel movements: 6.2±2/day. Fifteen (66%) patients had an elevated ESR or CRP and the average ESR and CRP were 36±21.4 and 6.5±7.8, respectively. Fourteen patients (56%) had an endoscopic score ≥2 and 8 (32%)≥3; Ten patients (40%) had a histologic score≥2 in at least one endoscopy. Moreover, in 9 patients (36%) endoscopic or histologic scores increased over a 5 year follow up. Four patients (16%) developed an episode of pouchitis within 5 years of follow up. Interestingly, in a control group of familial adenomatous polyposis pouch patients, increased inflammatory indices, endoscopic or histologic scores were not observed, and no episodes of pouchitis were reported. Conclusions: An ileal pouch in UC patients is an inflammatory condition per se. Subclinical inflammation exists in the majority of clinically “normal pouch” patients and tends to increase over time. Overt pouchitis developed at a rate of 16%/ five years. The lack of correlation between clinical, endoscopic and histologic scores necessitates their combined use for patient follow up. Anti inflammatory therapeutic interventions may be advised.