Pouchology.org

BACKGROUND: Patients undergoing ileal pouch-anal anastomosis (IPAA) for inflammatory bowel disease (IBD) commonly experience postoperative inflammatory complications, including pouchitis and cuffitis. While pelvic floor dysfunction has been associated with these complications, the predictive value of preoperative anorectal manometry (ARM) remains unclear. We evaluated the association between abnormal preoperative ARM and postoperative inflammatory outcomes in IPAA patients. METHODS: In this historical cohort study we assessed IPAA patients who underwent preoperative ARM with ileostomy closure during the period from January 2009 to December 2024. Patients were divided into 2 groups-normal vs abnormal pelvic floor function-based on ARM. Primary outcomes were a composite measure of endoscopic inflammatory pouch disease (EIPD) and endoscopic evidence of rectal cuffitis after the perioperative period. Secondary outcomes included individual components of the composite primary outcome. Multivariable logistic regression was used to assess associations while controlling for covariates. RESULTS: We included 179 patients in this study, 46 (25.7%) with abnormal ARM and 133 (74.3%) with normal ARM. In multivariable regression, abnormal ARM was associated with modestly increased odds of cuffitis (odds ratio [OR], 2.136; 95% CI, 1.050-4.345; P = .037) but was not associated with EIPD (OR, 1.490; 95% CI, 0.710-3.104; P = .287). Secondary outcomes were similar between groups, except for diffuse pouch inflammation, which was more frequently observed among patients with abnormal ARM (P = .024). CONCLUSIONS: Abnormal preoperative ARM was associated with increased odds of postoperative cuffitis but not composite endoscopic pouch inflammation in IPAA patients. Given the modest effect size and limited precision, these findings warrant confirmation in larger, prospective studies. In patients with ileal pouch–anal anastomosis (IPAA), pelvic floor dysfunction is associated with pouchitis and cuffitis. We assessed the association between preoperative dysfunction on anorectal manometry (ARM) and postoperative pouchitis and cuffitis. Abnormal ARM was associated with cuffitis, not pouchitis.

BACKGROUND: Pouchitis is the most common complication after ileal pouch anal anastomosis (IPAA), yet symptoms are non-specific, and diagnosis typically requires pouchoscopy. Fecal calprotectin (FC) is an established inflammatory bowel disease biomarker, but optimal thresholds and diagnostic performance across distinct pouch phenotypes remain unclear. METHODS: We performed an analysis of a prospectively maintained IPAA registry (2022-2025) at Mount Sinai Hospital. Adults with ulcerative colitis who had underwent total proctocolectomy with IPAA and had FC testing within ±90 days of pouchoscopy were included. Phenotypes were categorized as normal pouch (NP), acute pouchitis (AP), chronic pouchitis (CP), or Crohn's disease-like pouch inflammation (CDLPI). FC was compared across phenotypes and tested for associations with endoscopic Pouchitis Disease Activity Index (PDAI) sub-score, histologic activity, and symptoms using non-parametric tests, Spearman correlation, log-linear regression, and receiver operating characteristic analysis. RESULTS: Among 163 patients, FC differed significantly across pouch phenotypes (P <.01) with a median value of 50.5 µg/g in NP, 244 µg/g in AP, 370.5 µg/g in CP, and 231.5 µg/g in CDLPI. FC distinguished between inflammatory and normal pouches with an area under the curve (AUC) of 0.82, with an optimal threshold of ∼167 µg/g (specificity, 94%). FC correlated significantly with endoscopic PDAI sub-scores (Spearman ρ = 0.45, P <.001), and predicted severe endoscopic activity with an AUC of 0.82 and an optimal cutoff of 280 µg/g. CONCLUSION: FC is accurate for detecting and grading pouch inflammation. Thresholds near 167 and 280 µg/g reliably discriminate normal from inflamed pouches and mild from severe endoscopic disease, respectively. In this well-characterized cohort of patients with ulcerative colitis who underwent ileal pouch anal anastomosis, fecal calprotectin reliably detected and graded pouch inflammation.

This multicenter study evaluated clinical outcomes in pregnancy for women with ulcerative colitis and an ileal pouch-anal anastomosis. Close monitoring is needed with a multidisciplinary team for management of inflammatory complications of the pouch such as pouchitis in pregnancy and postpartum.

BACKGROUND: Inflammatory bowel disease (IBD) is increasing across Latin America (LATAM). We aimed to determine the frequency and characteristics of difficult-to-treat IBD (DTT-IBD) in this region, using international consensus criteria. METHODS: A retrospective study using data from IBD registries across 11 LATAM countries: the EPILATAM-IBD study (9 countries), the Brazilian national IBD registry, and 2 Argentinian single-center registries. Adults with ulcerative colitis (UC), Crohn's disease (CD), or unclassified IBD were included. DTT-IBD was defined as meeting at least one of the following criteria: failure of ≥2 advanced mechanisms of action, chronic antibiotic-refractory pouchitis, CD recurrence after ≥2 resections, or complex perianal CD. Comparisons between DTT and non-DTT groups were performed using Mann-Whitney and Chi-square/Fisher exact tests (P < .05). RESULTS: Among 5699 patients with complete data [40% CD, median disease duration 9 years (Q1-Q3: 5-15)], 747 (13%) met DTT-IBD criteria. DTT prevalence was higher with CD (30%) than among patients with UC (2%). Complex perianal disease predominated in DTT-CD (91%), whereas failure of ≥2 advanced mechanisms of action predominated in DTT-UC (93%). Compared to non-DTT patients, those with DTT-IBD were younger at symptom onset [median age 24 (19-34) years] and IBD diagnosis [26 (21-37) years], and had longer time to diagnosis (P-value<.001). DTT-CD was associated with penetrating behavior (39%) and ileocolonic disease (46%); DTT-UC with extensive colitis (83%). CONCLUSIONS: DTT-IBD affected 13% of patients treated in LATAM, with nearly one-third of individuals with CD presenting more severe phenotypic features. These findings highlight the need for comprehensive IBD care strategies in this complex patient population.