S788 Long-Term Use of Bile Acid Sequestrants to Improve Diarrhea and Abdominal Pain in IBD Patients With Ileoanal Pouch Anastomosis: A Tertiary Referral Center Experience

Abstract

Introduction: Bile acid (BA) sequestrants are commonly used in IBD following ileocecal resection to treat bile acid malabsorption and associated abdominal pain and diarrhea. There is less experience with use of BA binders in IBD patients following colectomy and ileoanal pouch reconstruction. IBD ileoanal pouch patients frequently experience bouts of diarrhea and abdominal pain and have limited treatment options. We sought to characterize our institutional experience with BA sequestrants to treat abdominal pain and diarrhea in a large cohort of IBD ileoanal pouch patients with a focus on longterm therapy and improvement in patient reported outcomes. Methods: We analyzed a prospective, natural history registry of consented IBD patients followed at a tertiary center (2009-2022). Patients with ileoanal pouch reconstruction following colectomy were identified and individuals with > 2 years of follow up formed the study cohort. BA sequestrants included cholestyramine, colestipol and colesevelam. Patient reported outcomes of diarrhea and abdominal pain, recorded at the time of clinic encounters were organized, and mean scores before and after bile acid binder therapy were compared. Results: There were 132 ileoanal pouch patients with longterm followup (mean age 51.8 + 13.9 years; 42% F; 58% M). BA sequestrants were initiated in 93 individuals and 63 patients (68%) continued therapy for >2 years, forming the multiyear therapy group. Patterns of BA sequestrant use included 48% receiving one, 41% trialing two and 11% using all three agents. The most commonly prescribed were colesevelam (48 patients), cholestyramine (33 patients) and colestipol (22 patients) and switching between BA sequestrants was commonly due to insurance coverage. The mean number of stools per day improved following initiation of BA sequestrants (p< 0.001). Abdominal pain scores also improved with longterm BA sequestrant therapy (p=0.017). Patterns of healthcare utilization improved with longterm BA sequestrant therapy with a reduction in annual patterns of emergency room visits (p=0.007) and hospitalizations (p< 0.001). (Figure) Conclusion: A majority of IBD ileoanal pouch patients benefitted from BA sequestrant treatment, reducing number of bowel movements and abdominal pain over a >2 year period, with a parallel reduction in healthcare utilization. Formal trials of BA sequestrants in the longterm management of chronic ileoanal pouch symptoms in the IBD patient population are warranted.Figure 1.: Results before and after bile acid sequestrants.