Is Preoperative Gastritis Associated with Long-Term Outcome after Ileal Pouch-Anal Anastomosis (IPAA)?: 1195

Purpose: Ileal pouch-anal anastomosis (IPAA) has become the standard approach for patients with ulcerative colitis (UC) or indeterminate colitis (IC) requiring colectomy. Despite excellent functional results and high patient satisfaction, a significant proportion of patients develop pouchitis or Crohn's disease (CD) after surgery. The aim of this study was to assess whether preoperative gastritis is associated with acute pouchitis (AP), chronic pouchitis (CP), or CD development in UC or IC patients undergoing IPAA. Methods: UC or IC patients undergoing IPAA having preoperative EGD were identified. EGD reports were reviewed for evidence of macroscopic gastritis (erythema, erosions or friability). Gastric histology was classified into the following categories: normal, reactive gastropathy, chronic active gastritis, or focally enhanced gastritis. Patients were prospectively assessed for the development of clinical and endoscopically proven pouchitis (AP = antibiotic responsive; CP = antibiotic dependent or refractory to antibiotic therapy) or CD (afferent limb inflammation or pouch fistula onset). Results: The 84 patients (UC = 56, IC = 28) had a median age of 37 yrs (range, 9–78) and included 48 males (57%). Macroscopic gastritis was present in 55 patients (65%) and histologically detected in 57 patients (67%). Reactive gastropathy, chronic active gastritis, and focally enhanced gastritis were identified in 29%, 45%, and 19% of subjects, respectively. After a median follow-up of 12 months, AP was seen in 14 patients (17%), CP in 7 patients (8%) and CD developed in 6 patients (7%). Compared to patients with no gastritis, patients with macroscopic gastritis were not more likely to develop AP (18% vs. 17%, p= NS), CP (5% vs. 19%, p= 0.09), or CD (5% vs. 13%, p= NS). Similarly, patients with microscopic gastritis were not more likely to develop AP (18% vs. 18%, p= NS), CP (5% vs. 18%, p= 0.07) or CD (5% vs. 14%, p= NS). The presence of reactive gastropathy, chronic active gastritis, or focally enhanced gastritis was not associated with a higher incidence of AP, CP or CD after IPAA. The lack of association between gastritis and AP, CP and CD onset after IPAA was observed in both UC and IC patient subgroups. Conclusions: Preoperative gastritis is common in UC or IC patients. However, these findings are not associated with the development of acute pouchitis, chronic pouchitis or CD after IPAA.