Clinical features and management of pouchitis in Japanese ulcerative colitis patients.

Purpose: Pouchitis frequently occurs after restorative proctocolectomy for ulcerative colitis. This study evaluated the incidence and treatment of pouchitis in Japanese ulcerative colitis patients.

Method: This study reviewed the clinical data from 772 patients with pouch surgery between January 2000 and December 2010. Pouchitis was classified as acute or chronic pouchitis. The potential preoperative risk factors for overall and chronic pouchitis were analyzed using a logistic regression analysis.

Result: The incidence of overall pouchitis and the cumulative risk of developing overall pouchitis were 10.0 % (77/772) and 10.7 % after 10 years, respectively. In addition, 74.0 % of all patients who developed overall pouchitis did so within 2 years after surgery. Chronic pouchitis occurred in 37.7 %. Although no independent risk factor for overall pouchitis was found, age at the onset of ulcerative colitis <26 years and surgical indications of toxic megacolon were found to be risk factors for chronic pouchitis and surgical indications of cancer/dysplasia were significantly associated with a low risk of overall pouchitis and patients with cancer/dysplasia were older than patients with other surgical indications (p < 0.01).

Conclusion: Immune abnormalities in younger onset patients or toxic megacolon may be more significant than surgical indications of cancer/dysplasia in elderly patients. Fundamental immune abnormalities may remain even after proctocolectomy.