The Natural History After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A Population-Based Cohort Study From the United States.

IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-06-18 DOI:10.14309/ajg.0000000000002891
Edward L Barnes, Aakash Desai, Jana G Hashash, Francis A Farraye, Gursimran S Kochhar
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引用次数: 0

Abstract

Introduction: There are limited data regarding the natural history after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). The principal objectives of this study were to identify 4 key outcomes in the natural history after IPAA within 1, 3, 5, and 10 years: the incidence of pouchitis, Crohn's-like disease of the pouch, use of advanced therapies after IPAA, and pouch failure requiring excision in a network of electronic health records.

Methods: We performed a retrospective cohort study in TriNetX, a research network of electronic health records. In addition to evaluating incidence rates, we also sought to identify factors associated with pouchitis and advanced therapy use within 5 years of IPAA after 1:1 propensity score matching, expressed as adjusted hazard ratios (aHRs).

Results: Among 1,331 patients who underwent colectomy with IPAA for UC, the incidence of pouchitis increased from 58% in the first year after IPAA to 72% at 10 years after IPAA. After propensity score matching, nicotine dependence (aHR 1.61, 95% confidence interval [CI] 1.19-2.18), antitumor necrosis factor therapy (aHR 1.33, 95% CI 1.13-1.56), and vedolizumab prior to colectomy (aHR 1.44, 95% CI 1.06-1.96) were associated with an increased risk of pouchitis in the first 5 years after IPAA. The incidence of Crohn's-like disease of the pouch increased to 10.3% within 10 years of IPAA while pouch failure increased to 4.1%. The incidence of advanced therapy use peaked at 14.4% at 10 years after IPAA.

Discussion: The incidence of inflammatory conditions of the pouch remains high in the current era, with 14% of patients requiring advanced therapies after IPAA.

溃疡性结肠炎回肠袋-肛门吻合术后的自然史:美国基于人群的队列研究。
背景:有关溃疡性结肠炎(UC)回肠袋-肛门吻合术(IPAA)后自然病史的数据非常有限。本研究的主要目的是确定 IPAA 术后 1 年、3 年、5 年和 10 年自然病史中的 4 个关键结果:电子病历(EHR)网络中的脓袋炎、脓袋克罗恩病样疾病(CLDP)、IPAA 术后先进疗法的使用以及需要切除的脓袋失败的发生率:我们在电子病历研究网络 TriNetX 中进行了一项回顾性队列研究。除了评估发病率外,我们还试图确定与IPAA后5年内发生脓袋炎和使用晚期疗法相关的因素,这些因素在1:1倾向得分匹配(PSM)后以调整后危险比(aHRs)表示:结果:在1331名接受结肠切除术和IPAA治疗UC的患者中,IPAA术后第一年的袋炎发生率为58%,IPAA术后10年的发生率为72%。在 PSM 后,尼古丁依赖(aHR 1.61,95% CI 1.19-2.18)、抗肿瘤坏死因子治疗(aHR 1.33,95% CI 1.13-1.56)和结肠切除术前使用维度珠单抗(aHR 1.44,95% CI 1.06-1.96)与 IPAA 术后前 5 年发生储袋炎的风险增加有关。在 IPAA 后的 10 年内,CLDP 的发生率增加到 10.3%,而胃袋衰竭的发生率增加到 4.1%。使用晚期疗法的发生率在IPAA术后10年内达到峰值,为14.4%:结论:在当今时代,胃袋炎症的发病率仍然很高,IPAA术后14%的患者需要接受晚期治疗。
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来源期刊
American Journal of Gastroenterology
American Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
11.40
自引率
5.10%
发文量
458
审稿时长
12 months
期刊介绍: Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.
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