Evolution of Extraintestinal Manifestations in Patients With Ulcerative Colitis Post-Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis: A Single-Center Retrospective Study.

Background and aims: Extraintestinal manifestations (EIMs) are common in patients with ulcerative colitis (UC). However, the prevalence and associated factors of EIMs in UC patients post-restorative proctocolectomy with ileal pouch-anal anastomosis (RPC + IPAA) are not well established.

Methods: We extracted clinical, demographic, and laboratory data of all UC patients who underwent IPAA surgery and followed up in our comprehensive pouch clinic between 2003 and 2021. EIMs were classified as musculoskeletal, mucocutaneous, ophthalmologic, and hepatic, and their frequency before and after the IPAA surgery was assessed. Univariate and multivariate analyses were performed to detect factors associated with EIMs.

Results: Included were 310 post-IPAA patients with a follow-up of 103.5 (1-250) months. EIMs were documented in 145/310 (46.78%) patients. Of them, 97 (66.9%) had musculoskeletal, 11 (7.59%) had mucocutaneous, 15 (10.34%) had hepatic, and 22 (15.17%) had a combination of 2 EIMs (including 3 ophthalmic cases). Preoperative EIMs were documented in 87/310 (28.1%) patients, and they persisted after the IPAA surgery in 72/87 (82.75%). The preoperative presence of musculoskeletal EIMs (odds ratio [OR]: 8.2, 95% confidence interval [CI]: 4.1-16.7, P = .0001), postoperative chronic pouchitis, and/or Crohn's-like disease of the pouch (OR: 2.2, 95% CI: 1.2-4.1, P = .01), as well as non-Ashkenazi origin (OR: 2.1, 95% CI: 1.1-3.9, P = .01) were associated with the prevalence of postoperative EIMs on a multivariate analysis.

Conclusions: The EIM rate increases post-IPAA surgery in UC patients, and most preoperative EIMs do not resolve. Awareness of the factors associated with EIMs will enable earlier detection and management for improving patient well-being and quality of life.