Association Between Immune-Associated Disorders and Adverse Outcomes of Ileal Pouch-Anal Anastomosis

Shen, Bo; Remzi, Feza H.; Nutter, Benjamin; Bennett, Ana E.; Lashner, Bret A.; Lavery, Ian C.; Brzezinski, Aaron; .Bambrick, Marlene L; Queener, Elaine; Fazio, Victor W.
March 2009
American Journal of Gastroenterology;Mar2009, Vol. 104 Issue 3, p655
Academic Journal
OBJECTIVES:Autoimmune disorders (ADs) frequently coexist with inflammatory bowel disease. The aim of the study was to determine whether coexisting AD in patients with ileal pouches increases the risk for chronic antibiotic-refractory pouchitis (CARP) and other inflammatory conditions of the pouch.METHODS:A total of 622 patients seen in our Pouchitis Clinic were enrolled. We compared the prevalence of adverse outcomes of the pouch (including CARP, Crohn's disease of the pouch, and pouch failure) in patients with or without concurrent AD and assessed the factors for these adverse outcomes.RESULTS:There were seven pouch disease categories: normal (N=60), irritable pouch syndrome (N=112), active pouchitis (N=131), CARP (N=67), Crohn's disease (N=131), cuffitis (N=83), surgical complications (N=36), and anismus (N=2). The prevalence of AD in these pouch disease categories was 4.5%, 12.5%, 9.2%, 13.4%, 10.7%, 3.8%, 1.5%, and 0%, respectively. The presence of at least one AD at time of pouch surgery was shown to be associated with a twofold increase in the risk for CARP (hazard ratio=2.29; 95% CI: 1.52, 3.46; P<0.001) and for pouch-associated hospitalization (hazard ratio=2.39; 95% CI: 1.59, 3.58; P<0.001). The presence of AD was not associated with increased risk for irritable pouch syndrome, active pouchitis, Crohn's disease, cuffitis, surgical complications, or pouch failure. Patients with Crohn's disease of the pouch had a 2.42 times higher risk for pouch failure (P=0.042) than these without. Active smoking or a history of smoking was shown to be associated with an increased risk for pouch-associated hospitalization and pouch failure.CONCLUSIONS:AD appears to be associated with an increased risk for CARP, and the presence of the association between these AD and pouch disorders may stimulate further research on the link of these organ systems on an immunological basis.Am J Gastroenterol 2009; 104: 655–664; doi:10.1038/ajg.2008.76; published online 3 February 2009


Related Articles

  • Disorders of a modern lifestyle: reconciling the epidemiology of inflammatory bowel diseases. Bernstein, Charles N.; Shanahan, Fergus // Gut;Sep2008, Vol. 57 Issue 9, p1185 

    The article offers a perspective on some of the more consistent epidemiological observations in inflammatory bowel diseases (IBD). It attempts to reconcile them with current concepts of disease mechanisms. The article discusses the environmental or lifestyle risk factors associated with IBD. It...

  • A dirty cure for inflammatory bowel disease.  // Gastrointestinal Nursing;Sep2008, Vol. 6 Issue 7, p4 

    The article reports on the role of exposure to harmless microbes early in life in lowering the risk of inflammatory bowel disease (IBD). The hygiene hypothesis postulates that children raised in an ultra-clean environment are more likely to develop IBD. It is said that environment as a key...

  • Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study. Jess, Tine; Frisch, Morten; Jørgensen, Kristian Tore; Pedersen, Bo Vestergaard; Nielsen, Nete Munk // Gut;Sep2012, Vol. 61 Issue 9, p1279 

    Background An association between endometriosis and certain autoimmune diseases has been suggested. However, the impact of endometriosis on risk of inflammatory bowel disease (IBD) remains unknown. Objective To assess the risk of Crohn's disease (CD) and ulcerative colitis (UC) in an unselected...

  • Solar Radiation and Vitamin D: Mitigating Environmental Factors in Autoimmune Disease. Schwalfenberg, Gerry K. // Journal of Environmental & Public Health;2012, p1 

    This paper looks at the environmental role of vitamin D and solar radiation as risk reduction factors in autoimmune disease. Five diseases are considered: multiple sclerosis, type 1 diabetes, rheumatoid arthritis, autoimmune disease of the thyroid, and inflammatory bowel disease. Clinical...

  • Clinical value of serum eosinophilic cationic protein assessment in children with inflammatory bowel disease. Wędrychowicz, Andrzej; Tomasik, Przemysław; Pieczarkowski, Stanisław; Kowalska-Duplaga, Kinga; Grzenda-Adamek, Zofia; Fyderek, Krzysztof // Archives of Medical Science;Dec2014, Vol. 10 Issue 6, p1142 

    Introduction: Eosinophils contribute to the pathogenesis of inflammatory bowel disease (IBD) in the intestine. Eosinophilic cationic protein (ECP) is one of the most important eosinophilic specific mediators released during activation. The aim of the study was to evaluate the clinical value of...

  • Analysis of Escherichia coli Isolated from Patients Affected by Crohn's Disease. Raso, Tiziana; Crivellaro, Sabrina; Chirillo, Maria; Pais, Paolo; Gaia, Ezio; Savoia, Dianella // Current Microbiology;Aug2011, Vol. 63 Issue 2, p131 

    The etiopathogenesis of Crohn's disease (CD) is still controversial: several genetic, immunologic, and environmental factors, including some bacteria, have been implicated. This study has been devised to assess the involvement of Escherichia coli in CD. Seven E. coli strains were isolated from...

  • Expression of p53, VEGF, microvessel density, and cyclin-D1 in noncancerous tissue of inflammatory bowel disease. Alkim, Canan; Savas, Berna; Ensari, Arzu; Alkim, Huseyin; Dagli, Ulku; Parlak, Erkan; Ulker, Aysel; Sahin, Burhan // Digestive Diseases & Sciences;Sep2009, Vol. 54 Issue 9, p1979 

    We aimed to evaluate the carcinogenesis risk in inflammatory bowel disease via p53 mutation and its relation with hyperproliferation (cyclin-D1) and angiogenesis (with vascular endothelial growth factor [VEGF] and microvessel density) and whether these events play important roles in pathogenesis...

  • Inflammatory bowel disease: is it really just another break in the wall? Weber, C. R.; Turner, J. R. // Gut;Jan2007, Vol. 56 Issue 1, p6 

    Although the critical factors necessary for IBD pathogenesis remain mysterious, interest in the potential role of defective epithelial barrier function continues to grow. New insight into the mechanisms responsible for barrier dysfunction in IBD may lead to understanding its contribution to...

  • Autoimmune diseases in patients with multiple sclerosis and their first-degree relatives: a nationwide cohort study in Denmark. Nielsen, N. M.; Frisch, M.; Rostgaard, K.; Wohlfahrt, J.; Hjalgrim, H.; Koch-Henriksen, N.; Melbye, M.; Westergaard, T. // Multiple Sclerosis (13524585);Jul2008, Vol. 14 Issue 6, p823 

    Background Multiple sclerosis (MS) and other autoimmune diseases might cluster. Our aim was to estimate the relative risk (RR) of other autoimmune diseases among MS patients and their firstdegree relatives in a population-based cohort study. Methods Using the Danish Multiple Sclerosis Register,...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics