P2674 - Primary Prophylaxis Reduces Risk of Pouchitis Among Patients with IPAA and Primary Sclerosing Cholangitis

John P. Haydek, MD, MS¹, Priscila Santiago, MD², Joseph Carter Powers, BA³, Latchmin Ruplall, ⁴, Hoang Anh Richardson, MD⁵, Erin Causey, MD⁵, Mohamed Hawary, MD⁶, Jana G. Hashash, MD, MSc⁷, Taha Qazi, MD⁸, Shannon Chang, MD⁹, Sara N. Horst, MD¹⁰, Frank I.. Scott, MD, MSc(Epi)¹¹, Rami Tfayli, MD⁷, Millie D. Long, MD, MPH¹², Laura E. Raffals, MD¹³, Edward Barnes, MD, MPH, FACG^14
1University of North Carolina at Chapel Hill, Chapel Hill, NC; ²University of Utah, Rochester, MN; ³Cleveland Clinic Lerner College of Medicine, Cleveland, OH; ⁴NYU Langone Health, New York, NY; ⁵Vanderbilt University Medical Center, Nashville, TN; ⁶New York University, Smithtown, NY; ⁷Mayo Clinic, Jacksonville, FL; ⁸Cleveland Clinic Foundation, Beachwood, OH; ⁹New York University Langone Health, New York, NY; ¹⁰Vanderbilt Inflammatory Bowel Disease Clinic, Nashville, TN; ¹¹University of Colorado Anschutz Medical Campus, Aurora, CO; ¹²Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC; ¹³Mayo Clinic, Rochester, MN; ¹⁴University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC

Introduction: Although restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is often depicted as a curative surgery for patients with ulcerative colitis (UC), many short and long-term complications can occur. Patients with a preoperative diagnosis of primary sclerosing cholangitis (PSC) are at a 4-times increased risk for developing pouchitis when compared to patients with UC undergoing IPAA. Despite this increased risk, there are no standardized approaches or guideline recommendations for the treatment of patients with PSC undergoing IPAA. We designed a retrospective study to address a knowledge gap regarding the role of primary prophylaxis against pouchitis among patients with PSC and UC undergoing IPAA.

Methods: A retrospective cohort was created from patients from 6 academic medical centers with a diagnosis of PSC and UC who underwent IPAA between January 1994 and May 2023. We collected data including demographics, medication use prior to IPAA, extraintestinal manifestations, and the use of primary prophylaxis medications after the final stage of IPAA. The primary outcome was a diagnosis of pouchitis at any point after IPAA. We also evaluated the development of chronic inflammatory conditions of the pouch (CP), defined as a diagnosis of chronic antibiotic-responsive pouchitis, chronic antibiotic-refractory pouchitis, or Crohn’s like disease of the pouch. Analysis was performed using descriptive statistics and one-sided Fisher’s exact test.

Results: Among 173 patients, 12 received primary prophylaxis (Table 1). Antibiotics were the most common prophylactic medication (5 patients), followed by probiotics (3 patients), and biologics, topical mesalamine, small molecules and immunomodulators (all 1 patient). Patients receiving any form of primary prophylaxis demonstrated significantly lower rates of acute intermittent pouchitis (66.7% vs. 91.3%, p=0.024; Figure 1) and CP (25.0% vs. 55.3%, p=0.041) when compared to patients with PSC and UC undergoing IPAA with no primary prophylaxis.

Discussion: Among patients with PSC and UC, the use of primary prophylaxis for pouchitis following IPAA creation reduced the rate of developing acute intermittent pouchitis and CP, although further subgroup analysis is limited due to very small sample sizes. Given the burden of acute intermittent and CP in this high-risk phenotype, further prospective study is needed to identify predictive factors of success with primary prophylaxis strategies and methods for implementation.



Disclosures:


John P. Haydek, MD, MS¹, Priscila Santiago, MD², Joseph Carter Powers, BA³, Latchmin Ruplall, ⁴, Hoang Anh Richardson, MD⁵, Erin Causey, MD⁵, Mohamed Hawary, MD⁶, Jana G. Hashash, MD, MSc⁷, Taha Qazi, MD⁸, Shannon Chang, MD⁹, Sara N. Horst, MD¹⁰, Frank I.. Scott, MD, MSc(Epi)¹¹, Rami Tfayli, MD⁷, Millie D. Long, MD, MPH¹², Laura E. Raffals, MD¹³, Edward Barnes, MD, MPH, FACG¹⁴. P2674 - Primary Prophylaxis Reduces Risk of Pouchitis Among Patients with IPAA and Primary Sclerosing Cholangitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.